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PubMed2005

Analysis of the molecular variability of Grapevine leafroll-associated virus 1 reveals the presence of two distinct virus groups and their mixed occurrence in grapevines.

Genetic diversity of eight Grapevine leafroll-associated virus 1 (GLRaV-1) isolates recovered from grapevines in three distinct locations in the Czech Republic and Slovakia was characterised by restriction fragment length polymorphism (RFLP) analysis and by sequencing of cloned 540 bp fragment of the heat shock protein 70 (HSP70) gene. Comparison and phylogenetic analysis of obtained and previously available sequence data revealed the existence of two groups of GLRaV-l isolates, tentatively named A and E (genetic divergence between A and E group reached 13.9%). An RT-PCR detection method followed by simple restriction analysis was developed, showing the potential to differentiate GLRaV-1 isolates of these groups. Interestingly, a mixed infection of two GLRaV-1 groups in the same plant was frequently detected together with a high intra-group variability in some isolates.

Amino Acid Sequence↗
PubMed2005

A decade of using intraluminal tracheal/bronchial stents in the management of tracheomalacia and/or bronchomalacia: is it better than aortopexy?

BACKGROUND: We compared the efficacy and clinical outcomes of aortopexy versus tracheal stents in the management of tracheomalacia. METHODS: A retrospective analysis of 25 consecutive patients undergoing aortopexy (n = 11; 8 boys, 3 girls) or tracheal stents (n = 14; 9 boys, 5 girls) between 1993 and 2003 was performed. RESULTS: Both treatment groups, aortopexy versus stents, were comparable in their mean age of diagnosis, timing of intervention, surgical indications ("dying spell" or failed extubation), and previous underlying conditions. The operative time (190 vs 72 minutes) and blood loss (26 vs 0 mL) were significantly greater in aortopexy group (P < .01). There were no perioperative deaths in either group. Interestingly, 4 of 11 patients in the aortopexy group developed pericardial effusion (P < .01). With stents in place for a mean of 15 (range 2-41) months, 3 of 8 patients with stent removal had significant granulation tissue requiring further dilatation. No death was observed in aortopexy group, whereas 1 stent-related death and 1 cardiac arrest requiring median sternotomy occurred during stent removal in 44 and 32 months' follow-up, respectively. CONCLUSION: Both aortopexy and tracheal stents are effective treatment modalities in the management of tracheomalacia. However, although aortopexy is associated with early perioperative complications, tracheal stents are associated with higher failure rate and more severe stent-related morbidity and mortality.

Aorta↗
PubMed2000

Inhibition of gap-junctional-intercellular communication in thyroid-follicular cells by propylthiouracil and low iodine diet.

Propylthiouracil (PTU) or low-iodine diet (LID) treatment increases thyroid-follicular-cell proliferation, possibly by disrupting the movement of small molecules (< 1.2 kD) through membrane channels called gap junctions. Numerous tumor promoters and proliferative disease states exhibit inhibited gap-junctional-intercellular communication (GJIC) prior to the induction of cell proliferation, yet the association between GJIC and apoptosis is unclear. In the present study, we used an ex vivo method to examine whether GJIC is inhibited in the thyroid of PTU- or LID-treated rats. In addition, the effect of these models of hypothyroidism on thyroid-follicular-cell proliferation and apoptosis was examined to determine the association between GJIC and cell homeostasis. After 14 days of treatment of either PTU or LID (plus 1% KClO4 in the drinking water), serum tri-iodothyronine (T3) and thyroxine, (T4) was decreased to nearly undetectable levels and serum TSH was increased in PTU- and LID-treated rats. At the same time point, GJIC was decreased 30-35% in PTU- and LID-treated rats while thyroid-follicular-cell proliferation increased nearly threefold in both treatment groups. Interestingly, apoptosis increased twofold in both hypothyroid treatment groups. These data suggest that PTU or LID treatment inhibit thyroid GJIC during a state of increased thyroid-follicular-cell proliferation and apoptosis. While the increase in proliferation was anticipated, the paradoxical increase in apoptosis during decreased GJIC in thyroid-follicular cells warrants further examination.

Animals↗
PubMed2001

Type of donor aortic preservation solution and not cold ischemia time is a major determinant of biliary strictures after liver transplantation.

The development of biliary strictures (BSs) after liver transplantation (LT) continues to affect 10% to 30% of patients, causing substantial morbidity. The cause of BSs is multifactorial, including technical, immune, and, in particular, ischemic factors. The importance of adequate flushing of the peribiliary arterial tree has been stressed. We hypothesized that high-viscosity (HV) preservation solutions in the donor do not completely flush the small donor peribiliary plexus, leading to inadequate preservation of the bile ducts and posttransplant BSs. To test this hypothesis, we retrospectively compared the incidence of BSs in 2 groups of adults undergoing LT using different types of aortic preservation solution in the donor: group 1 (n = 24), low-viscosity (LV) Marshall solution; and group 2 (n = 27), HV University of Wisconsin (UW) solution. All donors in both groups received additional portal flushes with UW. All LTs were performed between November 1995 and August 1998 at 2 centers by the same surgeon, eliminating a technical bias. Terminal duct-to-duct anastomosis was performed in all recipients except 1 patient in group 1, who underwent a bile duct-to-jejunum anastomosis. BSs were first suspected on clinical and biochemical grounds and then confirmed by endoscopic retrograde cholangiopancreatography. Identical medical protocols were used in all patients. One-year patient survival rates in groups 1 and 2 were 92% and 100%, respectively (P =.9). One-year graft survival was identical to patient survival. The incidence of BSs in group 1 was 4.1% (1 of 24 patients), compared to 29.7% in group 2 (8 of 27 patients; P =.02). The BS in group 1 occurred 4 months post-LT and was anastomotic. BSs in group 2 occurred between 1 and 12 months post-LT and were anastomotic, extrahepatic, intrahepatic, or combined intrahepatic and extrahepatic. There were no significant differences in the following factors between groups 1 and 2: donor age, local versus imported liver, split-liver or full-liver transplantation, incidence of multiple vessels in the donor liver, indications for LT, recipient age, T-tube versus no T-tube, post-LT peak aspartate aminotransferase level, and treatment for rejection. There was no hepatic artery thrombosis or primary nonfunction in either group. Interestingly, cold ischemia time (CIT) was longer in group 1, which had the least incidence of BSs (692 +/- 190 v 535 +/- 129 minutes in group 2; P =.001). Follow-up was longer in group 1 (28.9 +/- 8.3 v 15.6 +/- 8 months in group 2; P =.0001). Preservation costs per procurement were 1.9 times greater in the UW group than in the Marshall group. Donor aortic flushing with an HV preservation solution leads to more frequent BSs compared with an LV preservation solution. The impact of preservation solution outweighs the previously described deleterious impact of prolonged CIT. Mixed preservation solution (Marshall solution in the aorta, UW solution in the portal vein) might protect against BS formation while providing optimal liver graft preservation, function, and survival despite a mean CIT longer than 10 hours.

Adenosine↗
PubMed2006

Characterization of hyaluronan-binding proteins on guinea pig polymorphonuclear leukocytes: possible involvement of complement receptor type 3 (CR3, CD11b/CD18) in the hyaluronan-leukocyte interaction.

Hyaluronan (HA), a high-molecular-weight glycosaminoglycan ubiquitously present in the extracellular matrices (ECMs) of animals, plays important roles in ECM organization and cell behavior through binding to hyaluronan-binding proteins (HABPs). We previously reported that HA has anti-inflammatory effects on guinea pig phagocytes, although the nature of guinea pig HABPs was unknown. In this study, we characterized guinea pig HABPs on peritoneal polymorphonuclear leukocytes (PMNs) and blood neutrophils by flow cytometry and affinity chromatography. It was found that PMNs express diverse HABPs with different molecular weights. These HABPs maximally bound with HA over a wide pH range (6-8), and recognized HAs as small as the pentadisaccharide units of d-glucuronic acid and N-acetyl-d-glucosamine. Furthermore, they could be divided into Mg(2+)-dependent and Ca(2+)/Mg(2+)-independent groups. Interestingly, two proteins in the Mg(2+)-dependent group were found to be the two subunits of complement receptor type 3 (CR3, CD11b/CD18). Unlike PMNs, blood neutrophils expressed several functionally inactive HABPs. Among these inactive HABPs, Mg(2+)-dependent proteins including CR3 but not Ca(2+)/Mg(2+)-independent proteins were activated on phorbol ester-stimulation. These results show the existence of diverse HABPs on guinea pig neutrophils and the cell activation-dependent activation of HABPs. It is also suggested that the CR3-HA interaction is possibly involved in the regulation of neutrophil function.

Animals↗
PubMed2006

Effect of infliximab on mRNA expression profiles in synovial tissue of rheumatoid arthritis patients.

We examined the gene expression profiles in arthroscopic biopsies retrieved from 10 rheumatoid arthritis patients before and after anti-TNF treatment with infliximab to investigate whether such profiles can be used to predict responses to the therapy, and to study effects of the therapy on the profiles. Responses to treatment were assessed using European League Against Rheumatism response criteria. Three patients were found to be good responders, five patients to be moderate responders and two patients to be nonresponders. The TNF-alpha status of the biopsies from each of the patients before treatment was also investigated immunohistochemically, and it was detected in biopsies from four of the patients, including all three of the good responders. The gene expression data demonstrate that all patients had unique gene expression signatures, with low intrapatient variability between biopsies. The data also revealed significant differences between the good responding and nonresponding patients (279 differentially expressed genes were detected, with a false discovery rate < 0.025). Among the identified genes we found that MMP-3 was significantly upregulated in good responders (log2 fold change, 2.95) compared with nonresponders, providing further support for the potential of MMP-3 as a marker for good responses to therapy. An even more extensive list of 685 significantly differentially expressed genes was found between patients in whom TNF-alpha was found and nonresponders, indicating that TNF-alpha could be an important biomarker for successful infliximab treatment. Significant differences were also observed between biopsies taken before and after anti-TNF treatment, including 115 differentially expressed genes in the good responding group. Interestingly, the effect was even stronger in the group in which TNF-alpha was immunohistochemically detected before therapy. Here, 1,058 genes were differentially expressed, including many that were novel in this context (for example, CXCL3 and CXCL14). Subsequent Gene Ontology analysis revealed that several 'themes' were significantly over-represented that are known to be affected by anti-TNF treatment in inflammatory tissue; for example, immune response (GO:0006955), cell communication (GO:0007154), signal transduction (GO:0007165) and chemotaxis (GO:0006935). No genes reached statistical significance in the moderately responding or nonresponding groups. In conclusion, this pilot study suggests that further investigation is warranted on the usefulness of gene expression profiling of synovial tissue to predict and monitor the outcome of rheumatoid arthritis therapies.

Adult↗
PubMed2002

The effect of continuous ambulatory peritoneal dialysis on serum CA-125 levels.

Malignant and non-malignant serosal fluids were found to be associated with high serum levels of CA-125, suggesting that the presence of fluid in the serosal cavities may stimulate its release. In this study, we investigated the relationship between serum CA-125 levels and peritoneal irritation during continuous ambulatory peritoneal dialysis (CAPD). We performed a clinical study in 24 stable patients (15 amenstrual females and 9 males), aged 46 +/- 14 years on CAPD. The control group consisted of 32 healthy volunteers (20 females, 12 males) aged 44 +/- 12 years. CA-125 levels were determined prior to the CAPD dwell (without dialysate in abdomen) and during the CAPD dwell (dialysate in abdomen 4 hours after). As a result, serum CA-125 levels were found to be 14.86 +/- 5.98 U/ml and 15.23 +/- 6.05 U/ml respectively, whereas it was 8.32 +/- 5.54 U/ml in the control group. Serum CA-125 levels were found to be significantly elevated in CAPD patients when compared with healthy volunteers. However, serum CA-125 levels detected prior to and after CAPD did not differ between the groups. Interestingly, all of the patients in our study group were detected to have normal serum CA-125 levels (< 35 U/ml). We concluded that CAPD-induced abdominal artificial ascites did not affect serum levels of CA-125. Moreover, short and non-inflammatory mechanical pressures in the CAPD procedure do not have any effect on serum CA-125 levels.

Adolescent↗
PubMed2004

A global test for groups of genes: testing association with a clinical outcome.

MOTIVATION: This paper presents a global test to be used for the analysis of microarray data. Using this test it can be determined whether the global expression pattern of a group of genes is significantly related to some clinical outcome of interest. Groups of genes may be any size from a single gene to all genes on the chip (e.g. known pathways, specific areas of the genome or clusters from a cluster analysis). RESULT: The test allows groups of genes of different size to be compared, because the test gives one p-value for the group, not a p-value for each gene. Researchers can use the test to investigate hypotheses based on theory or past research or to mine gene ontology databases for interesting pathways. Multiple testing problems do not occur unless many groups are tested. Special attention is given to visualizations of the test result, focussing on the associations between samples and showing the impact of individual genes on the test result. AVAILABILITY: An R-package globaltest is available from http://www.bioconductor.org

Algorithms↗
PubMed1979

Tumors of the pineal and suprasellar region: Childrens Cancer Study Group treatment results 1960--1975: a report from Childrens Cancer Study Group.

Tumors of the pineal and suprasellar region form a rare and interesting group of lesions with germinomas accounting for over 50% of all lesions in this anatomic region. The Brain Tumor Committee of Childrens Cancer Study Group (CCSG) recently surveyed all CCSG member institutions to determine treatment parameters and assess the techniques. A total of 140 patients were seen during the period from 1960 to 1975; 118 patients were evaluable, having adequate treatment records. One hundred and one patients were less than 30 years of age with a 2:1 male predominance. Thirty-six of the 57 biopsied patients (63%) were found to have germinomas. The survival of patients in the germinoma group (72%) was comparable to that of the patients without biopsy (71%). The overall survival rate for all patients (biopsied and unbiopsied) was 65% with follow-up times ranging from 2 to 15 years. Nine patients developed spinal cord metastases (8%), two of whom also had simultaneous primary recurrence; none of these patients had received adjunctive spinal irradiation.

Adolescent↗
PubMed1995

Dietary lipid modification of myocardial eicosanoids following ischemia and reperfusion in the rat.

Several different edible oils were compared for their ability to modify eicosanoid biosynthesis following experimentally-induced myocardial ischemia and reperfusion in the rat. Two types of palm oil [neutralized, bleached, and deodorized (NBDPO) and refined, bleached, and deodorized (RBDPO)] and partially hydrogenated soybean oil (SBO) were tested against a diet supplemented with sunflower seed oil (SSO) rich in n-6 polyunsaturated fatty acids (PUFA). Fish oil (FO) rich in n-3 PUFA, with its known cardioprotective actions, served as an internal reference point for the study. Test oils were fed as a 12% (w/w) supplement for nine months before the induction of myocardial ischemia and reperfusion. Palm oil diets exerted effects indistinguishable from the SBO group against cardiac arrhythmia, which occurred following alterations to coronary blood flow. Arrhythmic potentials, as expressed by a hierarchical scale (0-9) of arrhythmia score, were: SSO, 1.5 +/- 0.5; FO, 0.9 +/- 0.4; SBO, 3.1 +/- 0.5*; NBDPO, 3.2 +/- 0.5*; RBDPO, 3.3 +/- 0.6*; *P < 0.05 vs. SSO. Following ischemia and reperfusion, both SSO and RBDPO groups tended to show an increase in myocardial prostacyclin, with the effect being more prominent in the RBDPO group (SSO, 10%; RBDPO, 25%). Thromboxane production was reduced in the FO group. Interestingly, cardiac muscle from both FO and palm oil groups displayed a reduced capacity to produce 12-hydroxyeicosatetraenoic acid SSO, 591 +/- 95.8; SBO, 375.5 +/- 48.9; NBDPO, 287.2 +/- 64.7*; RBDPO, 230.9 +/- 80.2**; FO, 203.7 +/- 81.4** (ng/g dry wt, *P < 0.05, **P < 0.01). No clear relationship was seen between the availability of 20:4n-6 in myocardial phospholipids and eicosanoid profile. Data suggests that fatty acid composition of edible oils is not the only determinant of arrhythmic vulnerability and eicosanoid production.

Animals↗
PubMed2001

British consultant rheumatologists' perceptions about the hypermobility syndrome: a national survey.

Three hundred and nineteen UK-based consultant rheumatologists, members of the British Society for Rheumatology (a response rate of 76%), responded to a questionnaire concerning their perceptions of the (benign joint) hypermobility syndrome (HMS). The questions were wide-ranging and covered the nature of the condition, its clinic prevalence, criteria for diagnosis, the efficacy of chosen treatments, the impact of the syndrome on affected individuals and the contribution that it makes to the overall burden of rheumatic disease morbidity. Ninety-two per cent of the respondents believed in the HMS as a distinct clinical entity but only 39% accepted it as a distinct pathological entity. Only 42% were prepared to comment on whether the HMS and Ehlers-Danlos syndrome, hypermobility type (formerly EDS type III) were one and the same entity. There was striking variability in estimated clinic prevalence and no consensus about the diagnostic criteria being used. There was little enthusiasm for treatments currently available. Nearly one-half of the respondents were sceptical about a significant impact of the HMS on people's lives and three-quarters about a significant contribution to the overall burden of rheumatic disease. There was little sign of awareness of findings in recent published studies. It seems unlikely, therefore, that evidence-based medicine is being practised in this area of rheumatology. An unexpected finding was a refreshing enthusiasm for joining regional interest groups on hypermobility (25% of all UK consultants expressed interest).

Diagnosis, Differential↗
PubMed2004

A comparison of the exponential decay slope between PEG-IFN alfa-2b/ribavirin and IFN alfa-2b/ribavirin combination therapy in patients with chronic hepatitis C genotype 1b infection and a high viral load.

OBJECTIVES: A high virological response rate can often be shown to be obtained with PEG-IFN alpha-2b and ribavirin combination therapy in chronic hepatitis C patients. Viral dynamics have been utilized for the evaluation of antiviral effects, especially the exponential second decay slope, which represents the elimination of infected cells. METHODS: Forty-nine patients were randomly assigned to the IFN alpha-2b group (n = 26) or the PEG-IFN alpha-2b group (n = 23). Ribavirin was administered equally to both groups. Measuring the serum concentration of HCVRNA, the exponential viral decay during phase 1 and 2 was calculated. RESULTS: The exponential decay slope in phase 2 during the first 2 weeks was greater in the IFN alpha-2b group than in the PEG-IFN alpha-2b group; however, from weeks 3 to 4, it was greater in the PEG-IFN alpha-2b group than in the IFN alpha-2b group. Interestingly, in the PEG-IFN alpha-2b group, the exponential decay slope was greater from weeks 3 to 4 after initiating combination therapy than during the weeks 1-2 (p < 0.01), despite administration of the same PEG-IFN alpha-2b dose (1.5 microg/kg once weekly). CONCLUSIONS: In PEG-IFN alpha-2b and ribavirin combination therapy, elimination of infected cells may be pronounced following an increase in serum ribavirin concentration in chronic hepatitis C patients with genotype 1b infection and a high viral load.

Adult↗
PubMed1991

The changing national policy system: complexity, Medicare, and implications for aging groups.

Changes in congressional processes, health agendas, and competitive positions of physician and hospital groups in the 1980s have produced important setbacks for such group interests within Medicare. Though united and successful in opposing Carter's 1977-79 hospital cost-containment proposals, these groups were subjected to severe new limits on hospital reimbursements under the 1982 budget reconciliation act. Thereafter, problems in protecting their interests continued or increased. Disagreements among hospital groups (e.g., the American Hospital Association and the former Federation of American Hospitals) surfaced over the Prospective Payment System introduced in 1983. In 1984, Congress instituted a freeze on physicians' Medicare fees despite AMA opposition. This projected narrow self-interest, thus decreasing the AMA's credibility. Further cost restrictions were imposed in 1985-86 budget acts. The problems of these organizations indicate that if aging groups are to protect their own stake in Medicare in the new political context, they must be particularly concerned with unity, credibility, and long-term perspectives.

Aged↗
PubMed1992

Physicians and alternative medicine--an investigation of attitudes and practice.

In the present paper, the attitudes of three different groups of physicians toward treatment with alternative medicine have been investigated. One of the groups studied consisted of randomly selected licensed physicians from the Swedish National Board of Health and Welfare. The other two groups comprised two different associations of physicians involved with alternative medicine. One third of the former groups were positively disposed toward one or more of the alternative medical technologies, while the latter groups were more positive toward alternative medicine in general. Attitudes, along with motives for such interest, varied depending on the orientations of the different interest groups. The most common motives for expressing interest in alternative medicine included a feeling of clinical powerlessness in the face of certain problems for which patients consult a physician, and a dissatisfaction with the scientific approach of academic medicine. A minority stated that their interest in alternative medicine pre-dated their medical education. Physicians' interest in alternative medicine can be understood both as a critical reaction to academic medicine and as evidence that some alternative medical technologies are effective. Hence there is a need to determine whether there are shortcomings to be found in academic medical education and scientific ideals, and also to assess alternative medical technologies at regular intervals.

Anthroposophy↗
PubMed2003

Training and education as a means of increasing equity in child health teaching of undergraduates.

Several primary sources of influence shape pediatric curricula in the United Kingdom and the United States. The national guidance given by the General Medical Council(1) in the United Kingdom and by the Future of Pediatric Education(2) document in the United States focus on developing a group of physicians who respond to the relevant needs of contemporary children. The competition among interest groups for time in curricula, including our interests in advancing community pediatrics, determines what is taught and the extent to which it is taught. Strategies to engage and motivate students so that they learn what we want them to learn ultimately will define our success in medical education and as medical educators. In approaching the above noted challenges, I have made 3 assumptions about learners. First, most students come from middle-class backgrounds and have little exposure to what life is really like for our patients and their families. Second, there is good evidence now that students' learning styles are set from the time they enter medical school.(3) Contemporary students are very assessment driven, and our residents are adopting these same sorts of attitudes. It is a protective mechanism for survival in a very crammed curriculum. The third assumption is that students have a wealth of experiences and creative energy, and there is much that we can do to harness them.

Child↗
PubMed2004

Nestin expression in hippocampal astrocytes after injury depends on the age of the hippocampus.

Analysis of the expression of nestin in reactive astrocytes facilitates quantification of the extent of activation of astrocytes after injury in the mature CNS. We hypothesize that the capability of astrocytes for re-expressing nestin in response to CNS injury diminishes as a function of age. We quantified astrocytes positive for S-100beta protein, glial fibrillary acidic protein (GFAP) and nestin in the hippocampus of young adult, middle-aged, and aged Fischer 344 rats after an intracerebroventricular kainic acid (KA) administration. In all age groups, KA administration induced degeneration of CA3 pyramidal neurons, which led to a significant deafferentation in the CA1 region. The KA-induced neurodegeneration and deafferentation resulted in an increased population of astrocytes positive for S-100beta and glial fibrillary acidic protein (GFAP) in all age groups. Interestingly, these increases were highly comparable across the three age groups. However, in areas of both neurodegeneration and deafferentation, the overall numerical density of nestin-positive reactive astrocytes varied depending on the age at the time of injury with noticeably decreased numerical density in the injured middle-aged and aged hippocampus. In contrast, nestin-immunoreactive radial glia framework after lesion is not impaired with aging in the ependymal lining of the CA3 region.

Aging↗
PubMed1995

The origins of the National Eye Institute 1933-1968. The Fifth Charles B. Snyder Lecture.

Many organizations and individuals prompted the authorization of the National Eye Institute by the United States Congress. The United States Marine Hospital and Public Health Service established a Laboratory of Hygiene in 1887, which became the research center of the National Institute of Health in 1930. The Albert D. and Mary Lasker Medical Foundation was mainly responsible for the 1945 conversion of the American Society for the Control of Cancer to the American Cancer Society, dedicated to medical research. Mildred Weisenfeld, a patient with retinitis pigmentosa, founded The Fight for Sight! in 1946 to provide funds for eye research. The Laskers invited Miss Weisenfeld to testify in support of a National Institute of Neurology, and her appeal was so persuasive that it emerged as the National Institute of Neurological Diseases and Blindness. Congressman John Fogarty and Senator Lister Hill directed the attention of the Congress and the public to the need for the Federal support of medical research. In 1960 Jules Stein, the legendary founder of the Music Corporation of America (MCA), established a new philanthropy, Research to Prevent Blindness, which provided skilled leadership in detailing the need for research in blinding disease and obtaining Congressional and Presidential approval of a new institute. The Committee for Research in Ophthalmology and Blindness was instrumental in bringing the groups interested in the welfare of the blind into harmony with groups concerned with medical research in blinding disease. The Association of University Professors of Ophthalmology was the first medical society to support the need for a National Eye Institute. The National Eye Institute was formally approved 8 August 1968 and celebrated its 25th anniversary in 1993.

History, 20th Century↗
PubMed1999

A pilot study evaluating the effectiveness of individual inpatient cognitive-behavioural therapy in early psychosis.

BACKGROUND: Recent research indicates that cognitive-behaviour therapy (CBT) can be effective in ameliorating persistent positive symptoms in chronic psychotic patients. The effectiveness of CBT in acute and recent-onset psychosis has been little explored, although a recent pilot study indicated that CBT could significantly improve recovery in acutely psychotic inpatients. METHOD: Short-term individual CBT was compared to supportive counselling/psychoeducation (SC) as an adjunct to standard inpatient hospital care and medication in 21 inpatients experiencing a recent-onset acute schizophrenic episode. RESULTS: Both groups showed significant reductions in Brief Psychiatric Rating Scale (BPRS) scores following treatment, although there were no group differences. Time to discharge did not differ significantly between the groups, although there was a greater variance for the SC patients. Two-year follow-up showed no significant differences between the groups, although the number of patients who relapsed, the number of relapses and the time to recurrence of psychotic symptoms was lower in the CBT group than the SC group. Interestingly, the time to readmission was shorter in the CBT group. CONCLUSIONS: CBT and SC are acceptable treatments for recent-onset acutely psychotic inpatients. A larger randomised controlled trial over multiple hospital sites is warranted.

Acute Disease↗