Journal Digest
Video Game an Alternative to Therapy for Teens?
Researchers at the University of Auckland and the University of Otago, both in New Zealand, have developed an interactive fantasy game designed to deliver cognitive-behavioral therapy to clinically depressed teens. Called SPARX (Smart, Positive, Action, Realistic, X-factor thoughts), the game uses first-person instruction and a three-dimensional interactive game in which the adolescent chooses an avatar and undertakes a series of challenges to restore the balance in a fantasy world dominated by GNATS (Gloomy Negative Automatic Thoughts). It consists of seven modules delivered over a period of four to seven weeks.
The program was tested at 24 primary health care sites in New Zealand, including youth clinics, general practices, and school-based counseling services. Adolescents aged 12 to 19 (n=187) seeking help for depressive symptoms and showing no major risk of self-harm were assigned to either SPARX or usual treatment.
The primary outcome was a change in score on the Children’s Depression Rating Scale–Revised. After the intervention, there was a mean reduction of scores for both groups, and the SPARX arm showed significantly higher remission rates, with improvements maintained at follow-up.
“SPARX is at least as good as usual treatment in primary health care settings in New Zealand,” wrote the researchers. “It could be used as the first component in a stepped-care approach to manage depression in this age group.”
The study was funded by the New Zealand Ministry of Health.
Merry S, Stasiak K, Shepherd M, et al. “The Effectiveness of SPARX, a Computerized Self-Help Intervention for Adolescents Seeking Help for Depression: Randomised, Controlled Non-Inferiority Trial.” BMJ. 2012. April 19 [Epub ahead of print]. www.bmj.com/content/344/bmj.e2598
CT Scans Raise Cancer Risk in Children
A CT scan may not be the best way to evaluate traumatic brain injury in a child, especially if he or she had a previous scan. A long-term retrospective study, funded by the U.S. National Cancer Institute and the U.K. Department of Health, indicated that CT scans pose potential cancer risks from associated ionizing radiation, particularly to children, who are more radiosensitive than adults.
The patients evaluated were first examined with CT between 1985 and 2002 when they were younger than age 22 at hospitals within 81 National Health Service (NHS) regional services in Great Britain. Linkage with the NHS Central Registry provided cancer incidence, mortality, and loss to follow-up from January 1, 1985, to December 31, 2008.
During follow-up, in a population of about 177,000 patients, 74 were diagnosed with leukemia and 135 were diagnosed with brain tumors, indicating a positive association between radiation dose from CT scans and leukemia and brain tumors.
The researchers said that the use of CT scans in children to deliver cumulative doses of about 50 mGy might almost triple the risk of leukemia, and doses of about 60 mGy might triple the risk of brain cancer, but because these cancers are relatively rare, the cumulative absolute risks are small. In the 10 years after the first scan for patients younger than age 10, one excess case of leukemia and one excess case of brain tumor per 10,000 head CT scans was estimated to occur.
The authors advised that clinical benefits should outweigh the small absolute risks, but radiation doses from CT scans ought to be kept as low as possible, and alternative procedures that do not involve ionizing radiation should be considered when appropriate.
Pearce M, Salotti J, Little M, et al. “Radiation Exposure From CT Scans in Childhood and Subsequent Risk of Leukaemia and Brain Tumours: A Retrospective Cohort Study.” Lancet. 2012. June 7 [Epub ahead of print]. www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)60815-0/abstract
Can Treating Frown Lines Cure Depression?
A single treatment of forehead frown lines with botulinum toxin may reduce the symptoms of major depression. Researchers at the Psychiatric University Hospital of the University of Basel, Switzerland, and the Hannover Medical School in Hannover, Germany, conducted a randomized, placebo-controlled, double-blind trial from August 2009 through October 2010. Participants were recruited from local psychiatric outpatient units, private-practice psychiatrists, or advertisements in the local press. The method under investigation—botulinum toxin treatment—was not explicitly mentioned in the advertisement to avoid attracting candidates who were motivated to receive the treatment for cosmetic reasons.
Both men and women aged 25 to 65 with major depressive disorder were included—all had a moderate to severe vertical glabellar line during maximum voluntary frowning. Participants were also required to demonstrate qualitatively and quantitatively stable treatment with one or, at most, two antidepressants for at least four weeks. A group of 263 subjects yielded the study group of 30 participants, who were randomized to treatment and placebo groups.
The treatment and placebo groups did not differ significantly in any of the baseline characteristics, but at the 16-week follow-up there was significant improvement in depressive symptoms in the treatment group as measured by the Hamilton Rating Scale for Depression. Treatment-dependent clinical improvement was also reflected in the Beck Depression Inventory and the Clinical Global Impressions Scale.
“This study shows that a single treatment of the glabellar region with botulinum toxin may shortly accomplish a strong and sustained alleviation of depression in patients who did not improve sufficiently on previous medication,” the researchers concluded.
The study was investigator-initiated and was carried out independently of any commercial entity, with funding from the Gottfried & Julia Bangerter-Rhyner-Stiftung Foundation.
Wollmer M, de Boer C, Kalak N, et al. “Facing Depression With Botulinum Toxin: A Randomized, Controlled Trial.” J Psychiatric Res. 2012. 46(5): 574-581. www.journalofpsychiatricresearch.com/article/S0022-3956(12)00038-6/abstract
Training in Mental Illness Self-Management Reduces Depression, Anxiety
Researchers from the University of Illinois and the Copeland Center for Wellness and Recovery in Brattleboro, Vt., recently published an assessment of a self-management intervention with an educational component that provides peer support and focuses on identifying wellness resources, symptom triggers, and warning signs of illness exacerbation. The program is called Wellness Recovery Action Planning (WRAP), and its goal is to increase self-perceived recovery and promote a healthy lifestyle.
Participants were 529 individuals with DSM-IV-TR serious psychiatric disorder (other than substance abuse) of at least 12 months’ duration. Researchers split the group into an intervention group (n=276) that enrolled in WRAP and a control group (n=279) that received standard treatment. Interventions for the WRAP group were delivered in eight weekly sessions for two and a half hours that included lectures, group exercises, and personal testimonies. Both groups were interviewed three times during the study to evaluate their self-perceived recovery using the Recovery Assessment Scale.
The intervention group’s scores showed a significant decrease in depression and anxiety compared with those for the control group, and participants in the WRAP program reported greater self-perceived recovery. The researchers said the results of their study build on previous research showing that WRAP consistently has a positive impact on recovery and go further by demonstrating the longitudinal effectiveness of the intervention: “Ours is the first randomized, controlled trial demonstrating conclusively that WRAP has a positive and sustained impact on feelings of depression and anxiety,” they wrote. “WRAP may create a supportive environment in which participants’ motivation for health behavior change is truly volitional, with peers acting as role models for recovery and offering ongoing support for lasting wellness.”
Cook J, Copeland M, Floyd C, et al. “A Randomized, Controlled Trial of Effects of Wellness Recovery Action Planning on Depression, Anxiety, and Recovery.” Psychiatr Serv. 2012. April 15 [Epub ahead of print]. www.ncbi.nlm.nih.gov/pubmed/22508435
