Journal Digest: IPSRT, Internet-Based CBT, Autism, IDD, Problem Drinking

Although interpersonal and social rhythm therapy (IPSRT) can improve functioning in patients with bipolar disorder, the therapy may not reduce the risk of mood relapse. This finding comes from a clinical study by investigators at the University of Otago in Christchurch, New Zealand, that was published in the American Journal of Psychotherapy.

IPSRT seeks to balance biological and social rhythms through the practice of regular daily routines, including sleep and other techniques to reduce stress.

The study included 88 patients with bipolar disorder who had recently been discharged from a mental health center. The patients were randomly assigned to IPSRT or usual treatment from their primary care physician for 18 months, with assessments performed every six months. The IPSRT participants also received a brief monthly medication management session from a psychiatrist.

At the end of 18 months, about 40% of patients in each group experienced at least one recurrent mood episode (depression or mania). Both groups also had similar scores on the Longitudinal Interval Follow-up Evaluation (which calculates the average severity of depression and mania symptoms over the previous six months) at each assessment.

The patients who received IPSRT reported statistically lower scores on the Social Adjustment Scale (which rates functioning across a range of family, work, and leisure domains) compared with those patients who received usual treatment. In addition, fewer patients receiving IPSRT required readmission to a mental health center compared with those who received usual care (14% versus 40%).

“Similar to self-management programs for chronic physical conditions, [IPSRT] was focused on promoting self-management and teaching the participants to live well in the presence of symptoms,” the investigators wrote. This focus may have been associated with the low readmission rate and improved functioning despite similar relapse events.

Hypochondriasis, anxiety about one’s health, is a common and potentially debilitating condition. In-person cognitive-behavioral therapy (CBT) is considered the best treatment for hypochondriasis, but a study appearing in JAMA Psychiatry reports that an internet-based CBT program for health anxiety may be as effective as face-to-face treatment.

Researchers at Sweden’s Karolinska Institute and colleagues randomly assigned 204 adults with health anxiety to either online CBT or 12 weekly in-person CBT sessions. The online program included 12 self-help modules, and the participants were encouraged to complete one a week. Online participants could also freely communicate with a therapist via email.

After 12 weeks, participants in both treatment groups showed similar reductions in health anxiety, as assessed with the 18-item Health Anxiety Inventory (scores in both groups dropped 11.3 points). The groups showed similar improvements in general anxiety and functional impairment as well.

The researchers calculated that online CBT would produce a lower net societal cost (which considers therapies, medications, nonmedical services, and indirect costs like unemployment) of about $3,800 per patient over the 12-week period. This was primarily due to lower therapist costs; therapists spent about 10 minutes communicating with each patient per week in the online treatment compared with 45 minutes face-to-face each week.

“Given the low societal costs of ICBT [internet CBT] for health anxiety, our findings highlight the potential benefits of implementing this treatment on a wider scale,” the authors concluded.

While early research suggested that symptoms of autism spectrum disorder (ASD) remain stable over the lifetime, a study in the Journal of Autism and Developmental Disorders now suggests ASD symptoms in children may change over time.

Researchers at the University of California, Davis MIND Institute analyzed data from 125 children (89 boys and 36 girls) with ASD, who at the age of 3 and 6 years underwent symptom severity and IQ assessments. Symptom severity was assessed with the 10-point Autism Diagnostic Observation Schedule Calibrated Severity Scores scale; a change of 2 points or more in either direction was considered significant.

About half of the children (54.4%) displayed stable symptom scores between the ages 3 and 6, while 16.8% exhibited increased severity and 28.8% exhibited decreased severity. The overall symptom severity at age 3 did not affect how symptoms changed over time; however, children with higher IQ scores at age 3 were more likely to experience a decrease in the severity of symptoms at age 6. Symptom severity was more likely to decrease and less likely to increase in girls than boys.

“These findings are somewhat at odds with the common notion that girls with autism are generally more impaired than boys,” the researchers wrote. “Yet, our results are consistent with many recent studies that suggest that girls might actually demonstrate better developmental outcomes than boys in the areas of cognition, sociability, and pragmatic communication skills.”

An analysis conducted by researchers at Syracuse University and colleagues suggests that individuals with intellectual and developmental disabilities (IDD), such as cerebral palsy or Down’s syndrome, are more likely to die from COVID-19 than those without IDD. This report was published in the Disability and Health Journal.

The researchers evaluated information contained in the TriNetX COVID-19 Research Network, a shared collection of electronic health record data from 42 health care organizations from around the world designed to facilitate COVID-19 research. The study included 474 COVID-19 patients with IDD and 29,808 patients without IDD.

The overall death rate for IDD and non-IDD COVID-19 patients was similar (5.1% and 5.4%, respectively). Significant differences emerged when looking at different age groups, however. Among patients aged 18 to 74, the death rate was 4.5% in patients with IDD and 2.7% in patients without IDD, while in patients aged 17 and younger, the death rate was 1.6% among patients with IDD and <0.1% among patients without IDD. Fatality rates were similar in patients aged 75 and older with and without IDD.

The researchers found that individuals with IDD in all age groups had a higher prevalence of comorbid circulatory, respiratory, and metabolic disorders. This may partly explain the increased risk of death in younger IDD patients who contract COVID-19. Another possible reason is that individuals with IDD are more likely to live in congregate settings like nursing homes, which are associated with worse COVID-19 outcomes.

Pacific Islanders remain heavily understudied in mental health research, which hinders clinical knowledge of this population’s psychiatric risk and treatment needs. A new study appearing in the American Journal of Orthopsychiatry reports on the rates of hazardous drinking and alcohol use disorder among this population.

The findings come from a survey of 156 Pacific Islander young adults (aged 18 to 30) across two communities: Los Angeles County and Northwest Arkansas. The survey was conducted by a team at the University of California, Riverside.

Participants were asked about alcohol, cigarette, and marijuana use, as well as their perceived need for mental health and/or substance use disorder services. Alcohol use was reported with the three-question Alcohol Use Disorders Identification Test-Concise (AUDIT-C).

In total, 78% of the respondents reported a history of alcohol use, and 56% screened positive for hazardous drinking (defined as an AUDIT-C score of 4 or higher for men and 3 or higher for women). In addition to the high rate of alcohol use, 53% and 54% of the respondents reported a history of cigarette and marijuana use, respectively; 30% of participants reported using all three substances.

Despite the prevalence of alcohol and substance use, only 25% of the survey respondents felt that they needed treatment for substance use disorder. Young adults who had experienced a drinking-related hazard (such as health or financial problems) were more likely to report needing treatment.

“Now that we’ve demonstrated that a major problem exists, we are starting to design culturally tailored interventions that could help these communities suffering excessive alcohol use and alcohol-related harms,” said lead investigator Andrew Subica, Ph.D., in a press release. ■