Background: Multiple Sclerosis (MS) affects quality of life (QoL). Pharmacological treatments demonstrated benefits on clinical endpoints without improving QoL. We evaluated the effects of a group Cognitive Behavioural Therapy (CBT) on QoL disease progression. Methods: One-year multi-centre controlled multivariate-matched study was organised on Relapsing-Remitting MS (RRMS) patients with Expanded Disability Status Scale (EDSS) < 4, MS duration < 2 years, treated by interferon I? in 11 French centres. For each new patient, the two best-matching patients for age, gender, EDSS, mood, illness duration baseline variables were selected in the other centres. The self-filled Two Lives Scale (TLS)-QoL10 was used at months (M) 0-3-6-9-12-15; the post-baseline mean QoL was the endpoint. We compared CBT + I? to I? alone. The effect of disease progression on QoL was evaluated by modelling, for each visit, the effect of EDSS on QoL at later visits.Results: 19 + 32 patients were recruited. Compared to placebo, improvements of 1.10 (95%CI [0.31-1.89], p = 0.009) and 1.43*** [0.72, 2.15] were observed in the CBT group on QoL and coping scales, respectively. Coping explained 81%*** [57, 100] of the effect of CBT on QoL. QoL was negatively affected by disease progression (0.95*** [-1.21; 0.63]), whereas EDSS was influenced by QoL values (-0.10*** [-0.14; -0.06]).Conclusions: We observed a clinically significant beneficial effect of CBT on QoL, the effect of CBT essentially explained by an increase of coping, a positive influence of QoL on disease progression. QoL is both the most important target for patients and a factor of slowing disease progression.
Aims: To examine the predictors and correlates of depression in alcoholic patients following detoxification and during outpatient treatment, and the role of acamprosate. Method: The international research program of acamprosate has involved 6500 patients in randomized, placebo-controlled trials. Extensive baseline and follow-up data were documented for each patient. An individual patient data meta-analysis was conducted on a partial database. Results: From 3354 patients in 11 studies (10 countries), we found 1120 (33.4% confidence intervals: 31.8–35.0) depressed patients (DPs). Among alcohol patients, the profile of DPs can be defined by five predictors: being female, younger, unemployed and living alone and being an episodic drinker. Compared with non-depressed patients (NDPs), their motivation to start a treatment and the compliance to treatment were lower. DPs performed less than NDPs in achieving abstinence. The acamprosate effect in increasing abstinence was similar for both DPs and NDPs patients. Abstinence during the trial was the key factor of depression remission: DPs were 7.58 times more likely to become NDPs if they were continuously abstinent. Conclusion: Our results justify the need to systematically identify depression among alcohol-dependent patients, but to treat the alcohol dependence as a first step, because enhancing abstinence will often involve remission of the depressive disorder.
