New Findings What is the central question of this study? Urotensin II is upregulated in patients in the later stages of chronic kidney disease (CKD), particularly in individuals requiring dialysis. Could treatment with a urotensin II receptor antagonist slow progression of renal disease? What is the main finding and its importance? In the rat, expression of urotensin II and its receptor increased, extending into cortical structures as CKD progressed towards end‐stage renal failure. Subchronic treatment with a urotensin receptor antagonist slowed but did not prevent progression of CKD. This suggests that urotensin II contributes to the decline in renal function in CKD. Abstract Elevated serum and urine urotensin II (UII) concentrations have been reported in patients with end‐stage chronic kidney disease (CKD). Similar increases in UII and its receptor, UT, have been reported in animal models of CKD, but only at much earlier stages of renal dysfunction. The aim of this study was to characterize urotensin system expression as renal disease progresses to end‐stage failure in a ⅚ subtotal nephrectomy (SNx) rat model. Male Sprague–Dawley rats underwent SNx or sham surgery and were killed at 8 weeks postsurgery [early (E)] or immediately before end‐stage renal failure [30 ± 3 weeks postsurgery; late (L)]. Systolic blood pressure, urinary albumin:creatinine ratio and glomerulosclerosis index were all increased in SNx‐E rats compared with sham‐E by 8 weeks postsurgery. These changes were associated with an increase in renal immunoreactive UII staining but little change in UT expression. As CKD progressed to end‐stage disease in the SNx‐L group, markers of renal function deteriorated further, in association with a marked increase in immunoreactive UII and UT staining. Subchronic administration of a UT antagonist, SB‐611812, at 30 mg kg −1 day −1 for 13 weeks, in a separate group of SNx rats resulted in a 2 week delay in the increase in both systolic blood pressure and urinary albumin:creatinine ratio observed in vehicle‐treated SNx but did not prevent the progression of renal dysfunction. The urotensin system is upregulated as renal function deteriorates in the rat; UT antagonism can slow but not prevent disease progression, suggesting that UII plays a role in CKD.

There is evidence that group cognitive behavioural therapy for psychosis (CBTp) is an effective treatment, but much of this research has been conducted with outpatient populations. The aim of this review was to determine the utility of group CBTp for inpatients. We systematically searched Scopus, Web of Science and EBSCO electronic databases to identify relevant research. We reviewed the resulting articles and included those which had been conducted with inpatients, with symptoms of psychosis, using cognitive behaviour therapy, delivered in a group format. Fourteen articles relating to ten studies were identified. Two were randomized controlled trials; two were cohort studies and the rest were pre-/post-intervention studies. There was considerable heterogeneity between the studies and all had methodological limitations. The findings suggest positive trends towards the reduction of distress associated with psychotic symptoms, increased knowledge of symptoms, decreased affective symptoms and reduced readmissions over several years. However, there is currently not enough evidence to draw any strong conclusions regarding the utility of group CBTp for inpatients due to the small number of studies and limitations in quality and generalizability. Therefore, this review indicates the need for further research, particularly large, methodologically rigorous, randomized controlled trials. ReferencesAho-Mustonen K, Miettinen R, Koivisto H, Timonen T, Raty H (2008). Group psychoeducation for forensic and dangerous non-forensic long-term patients with schizophrenia. A pilot study. European Journal of Psychiatry 22, 84-92. Aho-Mustonen K, Tilonen J, Repo-Tiihonen E, Ryynanen OP, Miettinen R, Raty H (2011). Group psychoeducation for long-term offender patients with schizophrenia: an exploratory randomised controlled trial. A randomised comparison of group cognitive-behavioural therapy and group psychoeducation in patients with schizophrenia. Acta Psychiatrica Scandinavica 110, 21-28. Bechdolf A, Knost B, Nelson B, Schneider N, Veith V, Yung AR, Pukrop R (2010). Randomized comparison of group cognitive-behaviour therapy and group psychoeducation in acute patients with schizophrenia: effects on subjective quality of life. Royal Australian and New Zealand College of Psychiatrists 44, 144-150. Bechdolf A, Kohn D, Knost B, Pukrop R, Klosterkotter J (2005). A randomized comparison of group cognitive-behavioural therapy and group psychoeducation in acute patients with schizophrenia: outcome at 24 months. Acta Psychiatrica Scandinavica 112, 173-179. Bickerdike A, Matias L (2010). Thinking about thinking: developing a meta-cognitive approach to group-based cognitive-behavioural therapy for psychosis in a medium secure setting. Clinical Psychology Forum 214, 31-35. Bright (2006). Star Wards: Practical Ideas for Improving the Daily Experiences and Treatment Outcomes of Acute Metal Health Inpatients. London: Bright. Canadian Psychiatric Association (2005). Clinical practice guidelines: the treatment of schizophrenia.

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