This study evaluates the effectiveness of safe offender strategies (SOS) in comparison with relapse prevention (RP) in a sample of 91 inpatient males in a secure psychiatric setting. All men evidenced a history of violent sexual offending and were diagnosed with serious psychiatric disorders and/or intellectual disabilities. Participants who received SOS (n = 58) and RP (n = 33) were followed from 6 to 36 months post release. SOS clients were significantly less likely to be arrested (0%) or rehospitalized (5.2%) than RP clients (9% arrested; 54.5% rehospitalized). In addition, SOS clients were more likely to transition continuously to less restrictive alternatives, with no returns to high security, in comparison with RP clients. The authors discuss implications for use of SOS, a treatment that facilitates skills development and affects global self-regulatory functioning, particularly in sex offenders with serious mental illness or intellectual impairment, in promoting community reintegration and limiting returns to psychiatric settings.

A major challenge in the treatment of major depressive disorder (MDD) is relapse, which is defined as the return of depressive symptoms during a period of remission. Relapse rates in MDD are high, with approximately 50% of individuals relapsing following treatment of their first depressive episode, therefore early intervention to prevent relapse is crucial. Evidence suggests that immune dysregulation may be linked to longitudinal changes in depressive severity. However, it is currently unknown whether inflammation can predict future relapse in MDD. The objective of this project was to identify potential immune predictors of relapse in participants that responded to a treatment or a combination of treatments for MDD. A secondary objective was to investigate immune composition in efforts to stratify MDD individuals into more homogenous groups and further explore these groups in relation to clinical symptoms. This project is part of the Wellness Monitoring for Major Depressive Disorder longitudinal study (NCT02934334) of responders to antidepressant treatment conducted at 6 clinical sites across Canada. Montgomery Asberg Depression Rating Scale (MADRS) scores were used to assess depression severity and to categorize participants into ultrastable, unstable, and relapse groups. Plasma immune profiles were generated using the LEGENDplex Human Th Cytokine Panel immunoassay. Principal Component Analysis and Kruskal-Wallis tests of individual immune cytokines did not show differences between ultrastable, unstable, or relapse groups. Principal Component Analysis did reveal two cytokine clusters. Hierarchical Clustering analysis identified three distinct immune biotypes characterized by differing levels of Th cytokines and validated the presence of the cytokine clusters. Neither of these outcomes was predictive of relapse in this cohort. Our findings have shown that immune composition may serve as an important factor in parsing heterogeneity that is observed in this disorder through identification of distinct immune biotypes and highly interconnected cytokine subnetworks in major depression. The potential for immune biotypes for optimizing treatment regimens and relapse prevention necessitates further investigation and replication. / Thesis / Master of Science (MSc)

Background: We aim to validate a seven-marker immunohistochemical signature, consisting of Bax, Bcl-X, PTEN, COX-2, (loss of) ß-Catenin, (loss of) MTAP and (presence of) CD20, in an independent patient cohort and test clinical feasibility. Methods: We performed staining of the mentioned antibodies in tissue of 88 primary melanomas and calculated a risk score for each patient. Data were correlated with clinical parameters and outcome (recurrence-free, distant metastasis-free and melanoma-specific survival). Results: The seven-marker signature was able to identify high-risk patients within stages IB-III melanoma patients that have a significantly higher risk of disease recurrence, metastasis, and death. In particular, the high sensitivity of relapse prediction (>94%) in sentinel negative patients (stages IB–IIC) was striking (negative predictive value of 100% for melanoma-specific survival and distant metastasis-free survival, and 97.5% for relapse-free survival). For stage III patients (positive nodal status), the negative predictive value was 100% with the seven-marker signature. Conclusions: The seven-marker signature can help to further select high-risk patients in stages IIB-C but also in earlier stages IB–IIA and be a useful tool for therapy decisions in the adjuvant and future neo-adjuvant settings. Stage III patients with measurable lymph node disease classified as high-risk with the seven-marker signature are potential candidates for neoadjuvant immunotherapy.

The aim of this study is to examine which individual and surrounding factors that are of importance for maintaining drug-freedom after treatment. The study is based on scientific papers found through a scoping review. The result of the study is thematized and analysed with the labelling theory, sense of coherence and the transtheoretical model stages of change. The results show that the individual factors involve occupation (employment, education and activities), health, thoughts and behaviour, network and aftertreatment, and emphasises the inner process and resources one by themselves can develop. The surrounding factors include occupation (employment, education and activities), network, aftertreatment and demographic factors. Here with the perspective on the support that comes from other groups, organisations and people. In the discussion there is a reasoning on the need for a view on relapse as something natural, and sometimes, part of the process. The path to a stable abstinence is not always a straight line or desirable goal, therefore the support should exist in every phase. Another central conclusion is that the Alcoholics Anonymous and Narcotics Anonymous gives a big support but is not used by everyone for different reasons. There should be similar support from public services. Future research could search factors for maintaining drug-freedom outside of the AA and NA community. The factors for stable abstinence could also differ depending on the type of abuse, which can be the subject for a possible future study.

It is quite noteworthy that relapse in substance use has been discussed more on an international level, than on a national level. In Sweden, research has focused on the recovery process, relapse avoiding strategies, and on relapse prevention treatment. Therefore, this study aims to describe and analyze individual and social risk factors for relapse in substance use from the perspective of both therapists and substance users. This is to analyze whether there are common denominators and/or major differences between these perspectives. Through qualitative interviews, where four therapists and four previously treated substance users were interviewed, we got access to different people’s substance use stories and opinions on relapse. To summarize our results, both users and therapists named triggers as negative emotions, and multi-problems such as mental health issues, but even damaged brain as an individual risk factor. They mentioned, furthermore, social relations, poor working alliance between users and professionals, and alcohol availability as Swedish tradition as social risk factors. Users alsomentioned exclusion and stigma in Sweden as social risk factors, meanwhile, therapists named loneliness as a social risk factor. These perspectives overlapped to a considerable extent, but therapists in some cases had a more scientific understanding of relapse.

Substance abuse is a global problem that has contributed to a variety of societal, financial, health, and familial strains. An increasing prevalence of illicit drug, prescription opioids, and alcohol abuse has created a need for re-evaluation of recovery and relapse treatments. This literature review examines the efficacy of meditation-based treatments for relapse prevention in persons recovering from Substance Use Disorders (SUDs). A comparative analysis of Mindfulness Based Relapse Programs (MBRP), an adapted MBRP-W program, and a Transcendental Meditation (TM) intervention was used to examine the success of meditation-based interventions. Research supports improvements associated with the meditation-based interventions including significant reductions in substance use, craving, stress, and negative affect. Meditation-based therapy may provide the emotional self-regulation and decreased impulsivity required for long-term abstinence from substance use. Consistent meditative practice was associated with greater improvements. Altering current meditation-based therapy treatment programs to encourage adherence and participation may increase success. Additional research is needed to evaluate long-term relapse prevention potential. Research incorporating meditation-based supportive therapies that promote well-being, emotion regulation, and stress relief are important for the future of successful SUD treatment.

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