Efficacy of a cognitive and behavioural psychotherapy applied by primary care psychologists in patients with mixed anxiety-depressive disorder: a research protocol

Background: In contrast with the recommendations of clinical practice guidelines, the most common treatment for anxiety and depressive disorders in primary care is pharmacological. The aim of this study is to assess the efficacy of a cognitive-behavioural psychological intervention, delivered by primary care psychologists in patients with mixed anxiety-depressive disorder compared to usual care. Methods/Design: This is an open-label, multicentre, randomized, and controlled study with two parallel groups. A random sample of 246 patients will be recruited with mild-to-moderate mixed anxiety-depressive disorder, from the target population on the lists of 41 primary care doctors. Patients will be randomly assigned to the intervention group, who will receive standardised cognitive-behavioural therapy delivered by psychologists together with usual care, or to a control group, who will receive usual care alone. The cognitive-behavioural therapy intervention is composed of eight individual 60-minute face-to face sessions conducted in eight consecutive weeks. A follow-up session will be conducted over the telephone, for reinforcement or referral as appropriate, 6 months after the intervention, as required. The primary outcome variable will be the change in scores on the Short Form-36 General Health Survey. We will also measure the change in the frequency and intensity of anxiety symptoms (State-Trait Anxiety Inventory) and depression (Beck Depression Inventory) at baseline, and 3, 6 and 12 months later. Additionally, we will collect information on the use of drugs and health care services. Discussion: The aim of this study is to assess the efficacy of a primary care-based cognitive-behavioural psychological intervention in patients with mixed anxiety-depressive disorder. The international scientific evidence has demonstrated the need for psychologists in primary care. However, given the differences between health policies and health services, it is important to test the effect of these psychological interventions in our geographical setting.

Is epizootic ulcerative syndrome (EUS) specific fungus of fishes a primary pathogen?: an opinion

Earlier findings on epizootic ulcerative syndrome (EUS) and the present observation of the authors on transmission of EUS to snakehead (Channa sp.) without skin damage provide evidence to suggest that the invasive fungus associated with EUS is a primary pathogen.

Regulation of primary production in the Gulf of California through interaction of large-scale and local ocean processes [abstract]

EXTRACT (SEE PDF FOR FULL ABSTRACT): The suppression of primary productivity observed in eastern boundary ecosystems of the Pacific during El Nino episodes does not occur throughout the Gulf of California. On the contrary, analysis of the modern siliceous phytoplankton record from annually layered sediments and compilation of available primary productivity measurements indicate that production is significantly increased in the central Gulf during El Nino years compared to anti-El Nino years. Integrated observations of biological and physical variability during the spring of 1983, under the influence of the strong El Nino, show that very high primary productivity occurred along the eastern margin of the central Gulf. This resulted from the upwelling of a nutrient rich source provided by the locally formed Gulf water mass originating in the northern Gulf. Lower productivity and phytoplankton biomass were associated with the anomalous penetration of Tropical Surface Water along the western side of the Gulf.