Biomedical subjects

H D Brenner

Publications and source records attributed to H D Brenner.

At least 19 recordsLinked to original sources

PubMed2007

[Effectiveness of Integrated Psychological Therapy for schizophrenia patients. A meta-analysis including 28 independent studies].

Over the past 24 years, research groups in eight different countries have conducted 28 independent evaluation studies on Integrated Psychological Therapy (IPT) including 1,329 schizophrenia patients. The present study examines the effectiveness of IPT under different treatment conditions by means of a meta-analytic review. The most salient results indicate favourable mean effect sizes for IPT in comparison to control groups (placebo-attention conditions, standard care). Moreover, the superiority of IPT continues to increase during an average catamnestic phase of 8.1 months. The method obtains similarly favourable effects in different functional areas (neurocognition, social behaviour, psychopathology) and different assessment formats (expert ratings, self-reports, psychological tests). The comparison of different settings of IPT and control groups shows the superiority of IPT in any given therapy or site condition. The analysis of subsamples of inpatients, outpatients, and patients in varying rehabilitation phases reveals similarly favourable effects. Comparing only high-quality studies yields comparable results. In summary, the present meta-analysis corroborates evidence that IPT is an 'empirically validated treatment' according to American Psychiatric Association guidelines.

Combined Modality Therapy↗

PubMed2006

Heavy use of acute in-patient psychiatric services: the challenge to translate a utilization pattern into service provision.

OBJECTIVE: There is an inequality in resource utilization among acute psychiatric in-patients. About 20-30% of them absorb 60-80% of the total resources allocated to this form of treatment. This study intends to summarize findings related to heavy in-patient service use and to illustrate them by means of utilization data for acute psychiatric wards. METHOD: Longitudinal assessment of consecutive acute in-patients hospitalized for the first time. Analysis of individual utilization patterns by using latent class cluster analysis. RESULTS: Four groups with different utilization patterns were found all including heavy service users. In most cases heavy service use was temporary and could only be poorly predicted. CONCLUSION: Specific preventive interventions to contain heavy service use seem to be out of reach for the majority of high utilizing patients. However, services that have proven effective in reducing admissions to in-patient treatment and length of stay may nevertheless help to reduce heavy service use.

Acute Disease↗

PubMed2002

Cerebral hemodynamic response induced by the Tower of Hanoi puzzle and the Wisconsin Card Sorting test.

Transcranial Doppler sonography (TCD) was applied in normal subjects to investigate the effect of prefrontal functions like the Tower of Hanoi (TOH) task and the Wisconsin Card Sorting test (WCST) on cerebral hemodynamics. In 20 healthy volunteers, left and right middle cerebral artery (MCA) and anterior cerebral artery (ACA) were insonated. The TOH task and the WCST were administered while cerebral blood flow velocity (CBFV) was registered. Each test was repeated once per artery pair. There was a visuomotor test to control the motor and visual stimulations. Three phases of CBFV time course were detected: an initial peak within 5 s, a following decrease within 25 s and a steady state beginning at 40 s. The TOH task, WCST and visuomotor tests had different mean CBFV during the initial peak (MCA: P<0.05; ACA: P<0.05) as well as for the decrease (ACA: P<0.01) and the steady state (MCA: P<0.01; ACA: P<0.01). The TOH showed an increased mean CBFV as compared with the WCST during the steady state (MCA: P<0.01; ACA: P<0.05). However, temporal modulation of mean CBFV during category shift of the WCST resulted in significantly increased values after category shift (MCA: P<0.001; ACA: P<0.01) as compared with CBFV before the category shift. These findings showed a different CBFV pattern during the TOH task and WCST than during the visuomotor test. In conclusion, TCD was able to assess CBFV in prefrontal functions, using a high resolution in time.

Adult↗

PubMed2002

Development of specific social skills training programmes for schizophrenia patients: results of a multicentre study.

OBJECTIVE: The efficacy of three newly developed cognitive social skills training programmes for residential, vocational and recreational functioning (experimental groups) were compared with a traditional social skills training programme (control group) referring to cognitive and social abilities, psychopathology and generalisation effects. METHOD: One hundred and five patients with a diagnosis of schizophrenia or schizoaffective disorder according to ICD-10 criteria were selected and assigned to the different treatment groups, using a matching procedure. The treatment phase lasted 6 months. A follow-up assessment was carried out after 1 year. RESULTS: Higher global therapy effects were obtained on almost all dependent variables in the experimental groups. Analyses of variance and covariance indicated higher symptom reduction for the experimental groups, but significantly greater improvements in some cognitive variables for the control group. Correlation analysis suggested associations between improvement of social behaviour with symptom reduction and improvements of cognitive skills. CONCLUSION: In view of these favourable effects, the developed cognitive social skills training programmes might facilitate the abilities of schizophrenia patients for their integration in the community.

Adult↗

PubMed2001

[Effects of new cognitive-behavioral therapy programs for improvement of specific social skills of schizophrenics--a controlled study].

Based on the Integrated Psychological Therapy (IPT) for schizophrenia patients, the Berne group developed three specific cognitive behaviour therapy programmes for treating residential, vocational, and recreational functioning. We added new cognitive-emotional methods to these programmes that were devised especially for schizophrenia patients, taking into consideration the criticism of traditional social skill training methods. In the present multicentre study, these new programmes (experimental group) were compared with a traditional social skills training programme (control group, IPT "Social Skills" subprogramme). Both the therapy and aftercare phase each lasted 12 weeks and the follow-up phase 1 year. Assessment instruments covered psychopathology, cognitive functioning, and social adjustment. Higher ratings of global treatment effects and significant reductions in symptoms were obtained in the experimental group. In view of the favourable results, these newly designed social skill training programmes may replace more conventional therapy approaches in the future.

Adult↗

PubMed2001

Improving recreational, residential, and vocational outcomes for patients with schizophrenia.

As Roder and colleagues propose, we have seen three eras in the development and refinement of social skills training for individuals with schizophrenia. In the 1960s, skills training relied on the use of operant conditioning, as exemplified by the token economy. Reinforcement contingencies succeeded in activating patients with negative symptoms and in improving their social behavior. Contemporary psychiatric rehabilitation can profit from the identification and use of reinforcers to motivate anergic individuals who lack insight to participate actively in community-based programs. During the second era, in the 1970s, social learning through modeling, coaching, role playing, and behavioral assignments was introduced into skills training. These techniques were used to improve nonverbal skills, such as eye contact, fluency of speech, gestures, and facial expression, as well as conversational skills, assertiveness, and emotional expressiveness. Intervention programs of the third and current era are incorporating cognitive methods into the skills training enterprise. For example, in the modules for training social and independent living skills developed and validated by Liberman and his colleagues at the University of California at Los Angeles (1), the deficits in attention, memory, and verbal learning often experienced by persons with schizophrenia are overcome by repetition, shaping of incremental behavioral improvements, video modeling, and feedback for galvanizing attention. Procedural learning techniques that do not rely on the brain capacities that mediate verbal awareness and insight are also used. In this month's Rehab Rounds column, Roder and his colleagues present another example of a skills training approach of the third era that includes elements of cognitive remediation. As autonomous offsprings of integrated psychological therapy (IPT), which was originally developed by Hans Brenner and Volker Roder and their colleagues at the University of Bern in Switzerland (2), the new programs address deficits in the residential, vocational, and recreational domains of community functioning. Overall, social skills training has been shown to be effective in the acquisition and maintenance of skills and their transfer to community life. Moreover, evidence is accumulating that structured and systematic skills training is more effective than other psychosocial treatments with which it has been compared, such as supportive group therapy and expressive modes of occupational therapy.

Activities of Daily Living↗

PubMed2000

[Community-integrated acute psychiatric care. Options and limitations].

The shift of psychiatric care from the hospital to the community has been accompanied by a reduction of hospital beds and shortened durations of inpatient treatment, but also by an increase in admissions. This evolution may be largely attributed to the prime focus of community mental health institutions on rehabilitation. The continued implementation of reforms in psychiatric care is contingent upon effectively halting the "revolving door phenomenon" by incorporating community-integrated treatment approaches into the care of acutely ill patients. Since the mid-1960s, a series of studies have established the efficacy of two community-integrated modalities for the treatment of acute psychiatric illness, i.e. home-based and day hospital treatment. In general, these approaches not only seem to be as effective as inpatient care for certain groups of patients but also reduce their need of hospitalisation, thereby contributing towards a cost effective, comprehensive psychiatric care system.

Acute Disease↗

PubMed2000

Nurse-patient sexual contact in psychiatric hospitals.

Sexual contacts between nurses and patients in psychiatric hospitals have not been investigated systematically. The aim of the present study was to determine the frequency of nurse-patient sexual relationships and their prominent characteristics on the one hand and the nurses' attitudes towards these contacts on the other. A questionnaire was mailed to 714 nurses employed at two psychiatric hospitals. Although 94% of the 279 respondents considered sexual contact (defined as "physical contact between a patient and a nurse, in which sexual arousal occurred in the nurse") to be inappropriate, 17% of the male and 11% of the female responding nurses reported having had such contacts with patients.

Adult↗

PubMed2000

Psychological therapy in schizophrenia: what is the evidence?

OBJECTIVE: The present contribution provides a critical outline of the current position of psychological therapies in schizophrenia. METHOD: Therefore, empirical research into the efficacy of psychological interventions in the treatment of schizophrenic disorders has been reviewed. RESULTS: Four cognitive-behavioural approaches have emerged as preeminently effective, or at least especially promising, as adjuncts to pharmacotherapy, i.e. the training of social skills, cognitive training programs for the remediation of neurocognitive deficits, psychoeducative, coping-orientated interventions with patients and their families, and cognitive-behavioural therapy of residual symptoms. These approaches are discussed with regard to their efficacy in reducing relapse rates, psychopathology as well as cognitive and social disability. CONCLUSION: Open questions and possibilities for the further development of these approaches are considered and prognostications are made concerning the future of psychotherapy research in schizophrenia, notably in the light of changing conditions in public health care systems.

Adaptation, Psychological↗

PubMed2000

[Vocational rehabilitation in chronic mental illness. The current position].

Vocational rehabilitation has long been of central importance in the comprehensive treatment of the psychiatrically disabled. This is reflected by the creation of a broad spectrum of vocational rehabilitation programs, ranging from inpatient and outpatient work therapy and sheltered employment to supported employment programs within the competitive labour market. Evaluation studies have shown that although sheltered vocational rehabilitation programs effect a significant rise in the work activity, rate of employment, job tenure and income of people with chronic mental illness in the alternative labour market, these programmes do not substantially increase job placement in the competitive labour market. By contrast, supported employment programs have proven more successful in achieving a higher integration rate in the competitive labour market for the chronically mentally ill. As opposed to the well-developed alternative labour market, supported employment programs are not broadly disseminated in German-speaking countries. Furthermore, vocational rehabilitation in general suffers from a lack of systematic evaluation and thus from inadequate scientific foundation.

Humans↗

PubMed2000

Effects of a coping-orientated group therapy for schizophrenia and schizoaffective patients: a pilot study.

OBJECTIVE: This controlled pilot study was designed, first, to examine the efficacy of two different group therapy formats for schizophrenia and schizoaffective patients: a patient-centred, psychoeducative and coping-orientated group therapy approach and a supportive therapy group. Secondly, it intended to establish preliminary hypotheses on the therapeutically relevant factors. METHOD: In a sample of 32 patients suffering from schizophrenia or a schizoaffective disorder the effect sizes of the coping-orientated therapy approach and a supportive group therapy on several outcome variables were examined and the predictive power of different effect variables on outcome was analysed. RESULTS: The effect sizes show improvements in the cognizance of the disorder and the related pharmacotherapy, the psychopathology and the social functioning for both therapy conditions. Moreover, outcome as measured after 1 year was best predicted by the patient's mastery of active, problem-focused coping strategies. CONCLUSION: The results corroborate the appropriateness of focusing on aspects of coping-behaviour in psychological interventions.

Adaptation, Psychological↗

PubMed2000

[Cognitive therapy for schizophrenic patients].

Neurocognitive deficits of schizophrenic patients are assigned to the following three levels of disorders: Information-processing, basic styles of thinking and emotional management. Cognitive interventions are schematically subdivided in direct, indirect and combined ones. Direct interventions are oriented straight at the disorder and contain exactly definable therapeutic steps inside of an experimental procedure. The focus of indirect interventions are the environment of the disorder with the purpose of modification and reorganisation. Combined interventions connect both approaches to get a decrease of the impairments of the symptoms and a long-term stabilization. Today, connections between the pattern of cognitive dysfunctions and the social functioning of schizophrenic patients are investigated. Verbal memory and vigilance seem to be good predictors of the community functioning. Further developments of cognitive therapies have to include multimodal approaches and unspecific therapeutic influences.

Cognitive Behavioral Therapy↗

PubMed1998

Training schizophrenic patients to manage their symptoms: predictors of treatment response to the German version of the Symptom Management Module.

This study examined whether patient demographic and clinical characteristics were predictors of differential treatment response in a sample of 57 schizophrenic patients who received the German version of the Symptom Management Module. Psychopathology, global functioning and knowledge about schizophrenia were assessed as dependent variables. Overall, patients improved over the treatment period on most dimensions of psychopathology as well as knowledge about psychosis. There was little evidence of differential treatment response as a function of either sociodemographic or clinical variables. However, gender was related to changes in psychopathology from pre- to posttreatment, with females improving less than males. Possible implications of these findings were discussed.

Adaptation, Psychological↗

PubMed1998

[Coping-oriented group therapy for patients with schizophrenic or schizoaffective disorders. An exploratory study].

The controlled study presented here was designed to examine the influence of the degree of structure of a coping-orientated therapy, the changes between the beginning and the end of therapy concerning satisfaction with therapy, psychopathology, attitude towards medication, coping behaviour and social variables, the effects on the days of hospitalisation within one year after the end of treatment and the relevant variables to predict the outcome twelve months later. It could be shown that patients in a relatively unstructured supportive group therapy wished to discuss topics that are very similar to those of coping-orientated therapy, that coping-orientated therapy results especially in an increase in knowledge about illness and treatment and that the therapeutic outcome after a one-year period can best be predicted by the degree of active coping strategies, social adaptation, trust in medication and cognitive variables.

Adaptation, Psychological↗

PubMed1998

Successful challenge with clozapine in a history of eosinophilia.

Eosinophilia has been encountered from 0.2 to 61.7% in clozapine-treated patients, mostly with a transient course and spontaneous remission. There have been few reports, however, which have investigated a challenge with clozapine in patients previously showing eosinophilia. Two case reports are presented: the first with clozapine challenge after eosinophilia, the second under clozapine treatment and no previous haematological side effects. The challenge case showed eosinophilia with 1.2 10(9)/l (z = 1.79, p = 0.04) being followed by normalization despite clozapine continuation, whereas the maximum value reached 2.1 10(9)/l in the single episode case, with consecutive normalization and uninterrupted treatment. Eosinophilia caused by clozapine was observed in challenge, preceded by a faster neutrophil production and consecutive decrease (z = 2.27, p = 0.01). A challenge with clozapine was feasible and showed no clinical symptoms of eosinophilia.

Adolescent↗

PubMed1998

Emotional management therapy in early psychosis.

BACKGROUND: Emotional management therapy (EMT) aims to improve handling of emotional stress in schizophrenia. It consists of two sub-programmes: the first includes relaxation techniques, the second stress coping skills. METHOD: A pilot study of EMT in 19 patients with early psychosis produced positive results and a post-hoc study of 16 patients was commenced. RESULTS: EMT showed positive results, with chronic patients improving more than patients with early psychosis. CONCLUSION: EMT can be effective in early psychosis, especially for cognitive functioning.

Adolescent↗

PubMed1996

[A training program for coping with maladaptive emotions of schizophrenic patients. Initial results and experiences].

Results of experimental psychological studies suggest that disorders in the emotional processing of schizophrenics are linked with disorders of their information processing. However, few therapeutic approaches tackle these disorders. Recently we developed a training scheme for improving emotional management by the use of individualized coping strategies. This paper describes a comparative study of this training in emotional management and an anti-stress therapy in 16 chronic schizophrenic patients. The results show significantly greater improvements in emotional perception, cognitive function and behavior for emotional management training. Additionally, after emotional management training, patients were able to develop protective strategies to help them to cope with everyday life.

Adaptation, Psychological↗

PubMed1995

[Status of the discussion regarding cost-effectiveness of community psychiatry and inpatient psychiatry].

In the current climate of escalating health care costs and shrinking resources, higher priority is also being given to the relation between costs and benefits of reform efforts and further developments of existing service delivery systems in the field of mental health. Some proponents of community psychiatry have predicted in a pointed manner that a change in the allocation of resources in favor of community-based care would dramatically decrease the need for hospital beds, cost half as much and be clinically at least as efficacious as inpatient treatment. The author gives careful consideration to these postulates based on today's available literature and on his own experiences in Mannheim and in Bern. He presents an array of newer findings which places them in perspective and to some extent contradicts them as well. Recent studies on the effects of an expansion of outpatient treatment programs on the overall mental health delivery system suggest that in areas with already reasonably developed community services its further enhancement rarely has an effect on the number of admissions to and length of hospital stays. In addition, the postulate that community care is considerably less costly only holds if in- and outpatient facilities are not considered to be integral parts of a comprehensive system of mental health care which both serve different purposes. Accordingly, the question of the effectiveness of treatment must also be discussed very distinctively. Although a network of well-functioning community-based services is (not yet) a veritable alternative, it can by all means, however, serve as a useful counterpart to the intensive treatment offered in modern mental institutions.(ABSTRACT TRUNCATED AT 250 WORDS)

Community Mental Health Services↗