This study examined the efficacy of an 8-week telephone-administered cognitive-behavioral therapy (CBT) for the treatment of depressive symptomatology in multiple sclerosis (MS) patients. The treatment, Coping with MS (CMS), included a patient workbook designed to structure the treatment, provide visual aids, and help with homework assignments. Thirty-two patients with MS, who scored at least 15 on the Profile of Mood States Depression-Dejection scale, were randomly assigned to either the telephone CMS or to a usual-care control (UCC) condition. Depressive symptomatology decreased significantly in the CMS condition compared with the UCC condition. Furthermore, adherence to interferon beta-1a, a disease-modifying medication for the treatment of MS, was significantly better at the 4-month follow-up among patients who received CMS as compared with those in the UCC condition.

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OBJECTIVE The aim of this analysis was to determine changing patterns of depression screening and diagnosis over three years in primary and specialty mental health care in a large health maintenance organization (HMO) as part of a quality measure development project. METHODS Two series of aggregate data spanning three years (2010–12) were gathered from the electronic health record of the HMO summarizing unique adolescents age 12–21 (N=44,342) who had visits in primary and mental health care. Chi-square tests assessed the significance of changing frequency and departmental location of PHQ-9 administration, incident depression symptoms, and depression diagnoses. RESULTS There was a significant increase in PHQ-9 use from 2010 to 2012, predominantly in primary care, consistent with internally generated organizational recommendations to increase screening with the PHQ-9. The increase in PHQ-9 use led to an increase in depression diagnoses in primary care and shift in the location of some diagnoses from specialty mental health care to primary care. The increase in PHQ-9 use was also linked to an increase in the proportion of positive PHQ-9 results not leading to formal depression diagnoses. CONCLUSIONS The rate of depression screening in primary care increased over the study period. This increase corresponded to an increase in the number of depression diagnoses made in primary care and a shift in the location of depression diagnoses made from the mental health department to primary care. The frequency of positive PHQ-9 administrations not associated with depression diagnoses also increased.

We compared outcomes of 45 depressed patients treated in private practice with cognitive therapy or with cognitive therapy plus pharmacotherapy to outcomes of patients receiving those treatments in two randomized controlled trials. Private practice and research samples differed considerably, with private practice patients having more psychiatric and medical comorbidities and a greater range of initial depression severity. Treatment in private practice and research settings also differed, with private practice treatment conducted in a more flexible manner using an idiographic, formulation-driven approach.As predicted, private practice patients showed statistically significant reductions in depressive symptomatology over the course of treatment, and at post-treatment, Beck Depression Inventory (BDI) scores of patients treated in private practice and research settings were not statistically significantly different.Clinical significance of outcomes was also comparable in the clinical and research samples.Of the variables measuring demographic, illness and treatment factors, only pre-treatment BDI score predicted post-treatment BDI score in the private practice sample.

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Conceptual and clinical problems arise in the treatment of patients with personality disorders, including three clinical problems: establishing and maintaining a therapeutic relationship with these patients is often difficult, empirically‐validated treatments for personality disorders are generally not available, and personality‐disordered patients typically have multiple presenting problems. We describe a case formulation model for conceptualizing and treating multiple‐problem patients, and outline how it addresses these difficulties arising in the treatment of patients with personality disorders.

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