Effectiveness of single-session therapy for adult common mental disorders: a systematic review

BACKGROUND

Common mental disorders (CMDs) impose significant socioeconomic impacts on the global community. Nevertheless, over 50% of individuals with CMDs do not receive proper treatment, indicating that the current treatment modalities do not adequately tackle this issue. Since single-session therapy (SST) is a potential method for reducing the treatment gap, it is crucial to evaluate its effectiveness. Therefore, this systematic review aimed to evaluate the effectiveness of SST on CMD symptoms in adults.

METHODS

This systematic review included randomised and non-randomised studies assessing the clinical effectiveness of SST on CMD symptoms in adults. English-written, peer-reviewed studies or dissertations were included, while grey literature was excluded. MEDLINE, Embase, PsycINFO, and Cochrane's CENTRAL were searched on December 13, 2022, from their inception dates. The risk of bias in the included studies was evaluated using RoB 2 and ROBINS-I. A narrative synthesis was performed. This systematic review was registered in the PROSPERO database on July 6, 2022 (CRD42022343925).

RESULTS

Six randomised and three non-randomised studies were included after screening 2,130 records. Three non-randomised studies with a "critical" or "serious" risk of bias were excluded from the synthesis. Therefore, six randomised trials involving 298 participants were included in the synthesis. Four out of six studies had a "high" risk of bias. The participants had non-severe symptoms at baseline, and three intervention types (behavioural activation, DBT, and solution-focused psychotherapy) were evaluated. Five of six studies showed positive results for depression, with only one reporting a positive result for anxiety.

CONCLUSIONS

SST may be effective in improving CMD symptoms in adults, particularly depression. However, there is a limit to deriving definite conclusions due to a high risk of bias in included studies, insufficient sample size and research volume. Further research exploring the characteristics of clients who can benefit from SST is required to facilitate its widespread use.

Stim1 Regulates Enamel Mineralization and Ameloblast Modulation

Loss-of-function mutations in the Ca²⁺ release-activated Ca²⁺ channel genes ORAI1 and STIM1 abolish store-operated Ca²⁺ entry (SOCE) and result in ectodermal dysplasia with amelogenesis imperfecta. However, because of the limited availability of patient tissue, analyses of enamel mineralization or possible changes in ameloblast function or morphology have not been possible. Here, we generated mice with ectodermal tissue-specific deletion of Stim1 ( Stim1 cKO [conditional knockout]), Stim2 ( Stim2 cKO), and Stim1 and Stim2 ( Stim1/2 cKO) and analyzed their enamel phenotypes as compared with those of control ( Stim1/2^fl/fl) animals. Ablation of Stim1 and Stim1/2 but not Stim2 expression resulted in chalky enamel and severe attrition at the incisor tips and molar cusps. Stim1 and Stim1/2 cKO, but not Stim2 cKO, demonstrated inferior enamel mineralization with impaired structural integrity, whereas the shape of the teeth and enamel thickness appeared to be normal in all animals. The gene expression levels of the enamel matrix proteins Amelx and Ambn and the enamel matrix proteases Mmp20 and Klk4 were not altered by the abrogation of SOCE in Stim1/2 cKO mice. The morphology of ameloblasts during the secretory and maturation stages was not significantly altered in either the incisors or molars of the cKO animals. However, in Stim1 and Stim1/2 cKO incisors, the alternating modulation of maturation-stage ameloblasts between the smooth- and ruffle-ended cell types continued beyond the regular cycle and extended to the areas corresponding to the zone of postmodulation ameloblasts in the teeth of control animals. These results indicate that SOCE is essential for proper enamel mineralization, in which Stim1 plays a critical role during the maturation process.

Inhibition of prostalglandin E2 production by 2'-hydoxychalcone derivatives and the mechanism of action

The effects of 14 synthetic 2'-hydroxychalcone derivatives on prostaglandin E2 (PGE2) production in rat peritoneal macrophages stimulated by the protein kinase C activator, 12-O-tetradecanoylphorbol 13-acetate (TPA), were examined to clarify the structure-activity relationship. 2',4-Dihydroxy-4'-methoxychalcone (compound 3), 2',4-dihydroxy-6'-methoxychalcone (compound 8) and 2'-hydroxy-4'-methoxychalcone (compound 9) suppressed PGE2 production more potently than the other compounds. The IC50 (50% Inhibitory concentration) value for compounds 3, 8 and 9 was calculated to be 3 microM. The activity of cyclooxygenase (COX)-1 was inhibited slightly by compound 9, but that of COX-2 was not inhibited. At concentrations that inhibited the production of PGE2, compound 9 had no effect on the release of radioactivity from [3H]arachidonic acid-labelled macrophages stimulated by TPA. Western-blot analysis revealed that the induction of COX-2 protein by TPA was inhibited by compound 9 in parallel with the inhibition of PGE2 production. Compounds 3 and 8 had similar effects. These findings suggest that 4'-methoxyl and 6'-methoxyl groups are required for the expression of more potent inhibitory activity against PGE2 production, and that the inhibition of PGE2 production by these 2'-hydroxychalcone derivatives is due to the inhibition of TPA-induced COX-2 protein expression.

Inhibition by tectorigenin and tectoridin of prostaglandin E2 production and cyclooxygenase-2 induction in rat peritoneal macrophages

Tectorigenin and tectoridin, isolated from the rhizomes of Korean Belamcanda chinensis (Iridaceae) which are used as Chinese traditional medicine for the treatment of inflammation, suppressed prostaglandin E2 production by rat peritoneal macrophages stimulated by the protein kinase C activator, 12-O-tetradecanoylphorbol 13-acetate (TPA), or the endomembrane Ca2+-ATPase inhibitor, thapsigargin. Tectorigenin inhibited prostaglandin E2 production more potently than tectoridin. Neither compound inhibited the release of radioactivity from [3H]arachidonic acid-labeled macrophages stimulated by TPA or thapsigargin. In addition, activities of isolated cyclooxygenase (COX)-1 and COX-2 were not inhibited by the two compounds. Western blot analysis revealed that the induction of COX-2 by TPA or thapsigargin was inhibited by the two compounds in parallel with the inhibition of prostaglandin E2 production. These findings suggest that one of the mechanisms of the anti-inflammatory activities of the rhizomes of Belamcanda chinensis is the inhibition of prostaglandin E2 production by tectorigenin and tectoridin due to the inhibition of the induction of COX-2 in the inflammatory cells.

[Evaluation of brain evoked potentials in the detection of subclinical hepatic encephalopathy in cirrhotics]

Brainstem auditory evoked potentials (BAEP), visual evoked potentials (VEP) and short latency somatosensory evoked potentials (SSEP) were examined in 30 nonalcoholic liver cirrhotics without clinically detectable hepatic encephalopathy and 30 healthy controls. In the cirrhotics, all peak latencies of the three kinds of evoked potentials, the interpeak latencies (IPLs) I-V, III-V of BAEP and the IPLs N13-N20, N13-P25 of SSEP were significantly prolonged compared with the controls, respectively. The amplitudes of P100, N125 of VEP were significantly lowered in the cirrhotics than those of the controls. Abnormal BAEP test and abnormal SSEP test results were found in both 60% of the cirrhotics, while VEP tests showed abnormalities in only 36.7%. In total, abnormal evoked potential test of one or more kinds were found in 90% of the cirrhotics. It is concluded that in cirrhotic patients, before the appearance of clinically encephalopathy, there were already brain evoked potential abnormalities or brain function changes. Our results argue in favor of the three kinds of evoked potential as the combined investigation for the sensitive and objective diagnosis of subclinical hepatic encephalopathy in patients with nonalcoholic cirrhosis.

[Short latency somatosensory evoked potentials in patients with ischemic heart disease]

Short latency somatosensory evoked potentials (SSEP) to median nerve stimulation recorded from post-Rolandic area and the surface of processus spinosus of Cvs at the same record time. To assess electrophysiologically functional status of central nervous system (CNS), SSEP were studied in 43 patients with ischemic heart disease (IHD); 18 cases of angina pectoris (AP group), 25 cases of old myocardial infarction (MI group), and 14 non-IHD controls (NC group). The N13, N20, P25 peak latencies (PLs) and the central conduction time (CCT, the peak latency between N13 and N20) in AP group or MI group were prolonged remarkably compared with NC group. Likewise, MI group showed significant prolongation of N20, P25 PLs and CCT compared to the AP group. Furthermore, in MI group, the N20 peak amplitude was significantly lowered; the subjects percentages of the N20 or P25 amplitude detraction more than 40 percent in one side and the P25 interextremital latency difference over 1 ms were significantly increased than those of the NC group. These results suggested the pathological changes of the somatosensory pathway from superior spinal cord or medulla oblongata to cerebral cortex primary sensory area in CNS in the IHD patients.

[Decreased brain function in patients with non-insulin-dependent diabetes mellitus]

Neurobehavioral and electrophysiologic studies were carried out to determine the effect of diabetes mellitus on brain function. Fifty one non-insulin-dependent diabetic patients were compared with 30 nondiabetic controls that are equally matched in age, sex and educational level. The aim of this study was to determine the change of brain function in diabetics, and to evaluate the correlation between brain function and clinical factors. The results showed: In the diabetic group, 'the Clinical Memory Test' performances on MQ, the five subtests were respectively lower than those of the controls. 'The Fourth Exception Test', 'the Motor Stability Test' and 'the Hospital Anxiety and Depression Scale' results were significantly disordered, too. The latencies of wave I, III, V of BAEP, wave N65 P100 N125 P160 of VEP, wave P1 N1 P2 N2 N3 P4 of SEP and the interpeak latency of I-V of BAEP were prolonged significantly compared with the controls. Within the diabetics, there was correlation between I-V interpeak latency of BAEP, P100 peak latency of VEP and serum creatinine. These results demonstrate that brain dysfunction are present in NIDDM, and these brain dysfunction correlate with the kidney function.

[Hypothalamic glioma with diencephalic syndrome and following precocious puberty--a case report]

A 1-year 11-month-old girl was admitted for losing her weight and gait disturbance. At 4 months of age, she began to become emaciated inspite of normal food intake. Physical and neurological examinations were normal except for a marked lack of subcutaneous fat, irritability and nystagmus. CT scans demonstrated a large tumor occupied in the third ventricle and marked dilatation of the lateral ventricles. Endocrinological studies revealed high levels of plasma growth hormone (GH) in contrast with normal levels of somatomedin-C. The basal value of GH returned to normal with a subnormal response to insulin subsequently after VP-shunt. Then, a pilocytic astrocytoma was partially resected with transcallosal approach. Postoperative course was uneventful and her growth rate returned to normal range. CT scans after radiation therapy of 49 Gy showed marked decrease in size of the tumor. At 3 years and 6 months of age, enlargement of her breast was pointed out although MRI indicated no enlargement of the tumor. Basal value of LH, FSH, E 1 and E 2 elevated and LHRH test showed over-response of LH and FSH. Other hypothalamic-pituitary functions were partially preserved. Case of precocious puberty following diencephalic syndrome associated to the hypothalamic and/or optochiasmatic glioma is quite rare in the previous literature. Mechanisms of diencephalic syndrome and following puberty are unclear. However, endocrinological and radiological findings observed in the present case suggest that hormonal disfunction might be due to the failure of inhibition on GH and LHRH secretion mechanism in the anterior hypothalamus.

[A case of syringomyelia associated with postoperative extradural cyst and adhesive arachnoiditis]

We report a rare case of syringomyelia associated with postoperative adhesive arachnoiditis and an extradural cyst. A 61-year-old male was admitted to our hospital five years after surgical removal of a cervical neurinoma. He complained of progressive quadriparesis and sensory disturbance. A CT scan showed a large cyst posteriorly within the C2, 3, 4 laminectomy area. MRI revealed syringomyelia with an extradural cyst at the C2, 3, 4 level. The operative findings revealed adhesive arachnoiditis on the dorsal surface at the C2, 3, 4 level and an extradural cyst communicating with the subarachnoid space through a dural defect on the left side of the C2 level. By excision of the extradural cyst and placement of a syringo-cisternal shunt, the syringomyelia shrank and the extradural cyst disappeared. It can be speculated that the pathogenesis of syringomyelia in this case was associated with ischemic change of the spinal cord due to compression and constriction caused by the extradural cyst and adhesive arachnoiditis.