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Biomedical subjects

Norah C Feeny

Publications and source records attributed to Norah C Feeny.

11 recordsLinked to original sources
PubMed2006

An evaluation of three brief programs for facilitating recovery after assault.

Ninety female recent assault survivors who met symptom criteria for posttraumatic stress disorder (PTSD) were randomized to one of three interventions: Brief Cognitive Behavioral Intervention, which focused on processing the traumatic event (B-CBT); assessment condition (AC); or supportive counseling (SC). Within 4 weeks of an assault, participants met weekly with a therapist for four 2-hr sessions. Across all interventions, participants reported decreases in PTSD symptoms, depression, and anxiety over time. At postintervention, participants in B-CBT reported greater decreases in self-reported PTSD severity and a trend toward lower anxiety than those in SC. At 3-month follow-up, participants in B-CBT evidenced lower general anxiety than those in SC and a trend toward lower self-reported PTSD severity. At last available follow-up (on average, 9-months postassault), all three interventions were generally similar in outcome. These findings suggest that a trauma-focused intervention aimed at those with severe PTSD symptoms after an assault can accelerate recovery.

Adult↗
PubMed2006

Cognitive-behavioral therapy for bipolar disorders in adolescents: a pilot study.

OBJECTIVES: To develop a cognitive behavioral intervention for adolescents with bipolar disorders, test its feasibility and preliminary efficacy. METHODS: Based on existing research, a manualized, individually delivered cognitive behavioral intervention was developed and tested with adolescents with bipolar disorders as an adjunct to pharmacological treatment. Using existing data, baseline characteristics and outcome were compared to a matched group of eight adolescents with bipolar disorders who did not receive any psychosocial intervention. RESULTS: Preliminary results support the feasibility and efficacy of this manualized cognitive behavioral intervention. CONCLUSIONS: Individually delivered cognitive-behavioral therapy (CBT) as an adjunct to pharmacological treatment is feasible and associated with symptom improvement in adolescents with bipolar disorders. Randomized controlled studies are needed.

Adolescent↗
PubMed2005

Randomized trial of prolonged exposure for posttraumatic stress disorder with and without cognitive restructuring: outcome at academic and community clinics.

Female assault survivors (N=171) with chronic posttraumatic stress disorder (PTSD) were randomly assigned to prolonged exposure (PE) alone, PE plus cognitive restructuring (PE/CR), or wait-list (WL). Treatment, which consisted of 9-12 sessions, was conducted at an academic treatment center or at a community clinic for rape survivors. Evaluations were conducted before and after therapy and at 3-, 6-, and 12-month follow-ups. Both treatments reduced PTSD and depression in intent-to-treat and completer samples compared with the WL condition; social functioning improved in the completer sample. The addition of CR did not enhance treatment outcome. No site differences were found: Treatment in the hands of counselors with minimal cognitive- behavioral therapy (CBT) experience was as efficacious as that of CBT experts. Treatment gains were maintained at follow-up, although a minority of patients received additional treatment.

Academic Medical Centers↗
PubMed2004

Somatic treatment for depressive illnesses in children and adolescents.

Numerous somatic interventions have been studied as potential treatments of depressive disorders in children and adolescents. These include antidepressant medications, light therapy, electro-convulsive therapy, and alternative therapies. The available evidence suggests that several somatic interventions hold promise as potentially safe and effective treatments for depressed youths; however, there is still much to be learned about these interventions. This article reviews what is known and what needs to be learned about the somatic treatment of pediatric depression.

Adolescent↗
PubMed2004

Sequential treatment for child abuse-related posttraumatic stress disorder: methodological comment on Cloitre, Koenen, Cohen, and Han (2002).

M. Cloitre, K. Koenen, L. R. Cohen, and H. Han (2002; see record 2002-18226-001) presented results of a randomized trial that clearly demonstrate the safety and efficacy of a treatment program delivering skills training in affective and interpersonal regulation (STAIR) prior to conducting imaginal exposure (IE) to trauma memories for adults with posttraumatic stress disorder (PTSD) related to childhood abuse. In this comment the authors review the results presented by Cloitre et al and specifically compare the impact of the STAIR and IE phases of the treatment on affect regulation and psychopathology measures. Evidence for adverse events associated with exposure therapy is reviewed. The authors emphasize that the present study should not be interpreted as evidence that pretreatment with STAIR is additively helpful or necessary prior to IE for PTSD associated with child abuse and that a between-groups comparison is necessary before such conclusions can be drawn.

Adult↗
PubMed2003

Treatment choice for PTSD.

The impetus for seeking help for assault-related difficulties often rests upon the victims themselves. Yet, we know very little about what factors influence a woman's decision to seek a particular kind of help after an assault. To learn more about these factors, data from 273 women with varying degrees of trauma history and subsequent PTSD symptoms were collected. All participants read a standard, "if this happened to you, what would you do" scenario describing a traumatic event and subsequent trauma-related psychiatric symptoms. Participants were given the same trauma scenario (i.e., sexual assault) and three treatment options to choose from: sertraline (SER), prolonged exposure (PE), or no treatment. Ratings of treatment credibility, personal reactions to treatment options, and treatment choice were examined. Women were more likely to choose PE than SER for the treatment of chronic PTSD. Perceived credibility of the treatment and personal reactions coincided with women's choices. By better understanding who would choose which treatments for PTSD and why, we will improve our ability to tailor how we approach discussing treatment options with these women.

Adult↗
PubMed2002

Somatic treatment for depressive illnesses in children and adolescents.

Numerous somatic interventions have been studied as potential treatments of depressive disorders in children and adolescents. These include antidepressant medications, light therapy, electro-convulsive therapy, and alternative therapies. The available evidence suggests that several somatic interventions hold promise as potentially safe and effective treatments for depressed youth; however, there is still much to be learned about these interventions. This article reviews what is known and what needs to be learned about the somatic treatment of pediatric depression.

Adolescent↗
PubMed2002

Does imaginal exposure exacerbate PTSD symptoms?

Symptom exacerbation (i.e., treatment side effects) has often been neglected in the psychotherapy literature. Although prolonged exposure has gained empirical support for the treatment of chronic posttraumatic stress disorder (PTSD), some have expressed concem that imaginal exposure, a component of this therapy, may cause symptom exacerbation, leading to inferior outcome or dropout. In the present study, symptom exacerbation was examined in 76 women with chronic PTSD. To define a "reliable" exacerbation, we used a method incorporating the standard deviation and test-retest reliability of each outcome measure. Only a minority of participants exhibited reliable symptom exacerbation. Individuals who reported symptom exacerbation benefited comparably from treatment. Further, symptom exacerbation was unrelated to dropout. Thus, although a minority of individuals experienced a temporary symptom exacerbation, this exacerbation was unrelated to outcome.

Adult↗
PubMed2002

Treatment outcome for chronic PTSD among female assault victims with borderline personality characteristics: a preliminary examination.

The present study examined the effect of the presence of borderline personality disorder characteristics (BPC) on patients' responses to cognitive behavioral treatment for chronic PTSD. Seventy-two female victims of sexual and non-sexual assault were randomly assigned to one of four treatment conditions: prolonged exposure (PE), stress inoculation training (SIT), combined treatment (PE/SIT), and wait list control (WL). Treatment consisted of nine bi-weekly individual sessions. Seventeen percent of the patients met full (10%) or partial criteria (7%) for borderline personality disorder. A greater number of patients with BPC reported sexual assault in childhood compared to those without the symptomatology. Patients with BPC also reported more pre-treatment anger. In general, those with BPC benefited significantly from treatment, although at post-treatment, they were less likely to achieve good end-state functioning than those without such symptomatology. The relationship between BPC and treatment response will be discussed.

Adult↗
PubMedDate not supplied

The relevance of pharmacokinetic studies in designing efficacy trials in juvenile major depression.

INTRODUCTION: Identifying evidence-based dosing strategies is a key part of new drug development in pediatric populations. Pharmacokinetic (PK) studies can provide important information regarding how best to dose medications in children and adolescents. Utilizing scientifically supported dosing strategies provides the best chance for any given drug to demonstrate both efficacy and acceptable tolerability in definitive, placebo-controlled studies. METHODS: Results of both PK studies and randomized, placebo-controlled efficacy trials (RPCTs) in juvenile major depressive disorder (MDD) are reviewed. The degree to which the medication dosing strategies that were employed in the efficacy studies were supported by the extant PK data is considered. Medications that are reviewed include fluoxetine, sertraline, paroxetine, citalopram, escitalopram, venlafaxine, nefazodone, and mirtazapine. RESULTS: In many instances, the dosing paradigms that were used in the RPCTs differed, sometimes substantially, from the dosing strategies that would have been supported based on the results of PK studies. CONCLUSIONS: Medication dosing regimens may have contributed to the failure of several RPCTs to show drug efficacy in the treatment of pediatric MDD. In addition, the doses of medication used in these RPCTs may also have contributed to the safety and tolerability concerns that have been raised with these drugs. PK and dose-ranging studies should be performed prior to the initiation of definitive efficacy trials so that empirically supported dosing strategies can be incorporated into the design of RPCTs of antidepressants in children and adolescents suffering from MDD.

Adolescent↗