Biomedical subjects

J A Jenner

Publications and source records attributed to J A Jenner.

18 recordsLinked to original sources

PubMed2003

Cost-effectiveness of the HIT programme in patients with schizophrenia and persistent auditory hallucinations.

OBJECTIVE: To examine the cost-effectiveness of Hallucination focused Integrative Treatment (HIT) in patients with schizophrenia and a history of persistent auditory hallucinations. METHOD: Costs, in and outside the health care sector, and outcomes were registered prospectively during a period of 18 months for patients who received the HIT programme and for patients in the care as usual (CAU) condition. The Positive and Negative Syndrome Scale (PANSS) was used as main outcome measure in the cost-effectiveness analysis. Bootstrap analyses provided additional information on the skewly distributed costs. RESULTS: Mean costs per patient in the HIT group (18,237 dollars) were lower than the mean costs per patient in the CAU group (21,436 dollars). Results of the PANSS were slightly in favour of the HIT group. CONCLUSION: There appears to be no significant cost-effectiveness advantage of the HIT programme over CAU. Additional analyses indicated that future application of the HIT programme will, in most cases, lead to a reduction of (non) medical costs.

Adult↗

PubMed2002

Effects on depression pharmacotherapy of a Dutch general practitioner training program.

BACKGROUND: General practitioners' (GPs) ability to recognize, diagnose and treat depression improved significantly after a comprehensive, 20-h training programme. This study aims to evaluate in more detail the effects of the training on GPs' pharmacotherapy of depression and related issues. METHODS: A pretest-posttest design was used. Both in the pre- and post-training phase, a sample was drawn from consecutive patients of the 17 participating GPs. In the pre-training phase we identified a sample of 31 cases with an ICD-10 depression who received an antidepressant from their GP. The sample was followed for 1 year. Outcome measures were: type of antidepressant, dosage, duration and number of target instructions given by the GP. Then we trained the GPs. In the post-training phase, we identified a new sample (n = 47) from their practices and measured the same outcomes. RESULTS: Improvements were seen in choice for modern antidepressant, adequate dosage, adequate duration, and number of target instructions given. LIMITATIONS: Observed changes can be due to a period effect, inherent in a pre-post design. CONCLUSIONS: A post-academic hands-on training of GPs can improve depression pharmacotherapy according to clinical guidelines with respect to choice of a modern antidepressant, adequate dosage, adequate duration and psychoeducation.

Adolescent↗

PubMed2001

HIT, hallucination focused integrative treatment as early intervention in psychotic adolescents with auditory hallucinations: a pilot study.

OBJECTIVE: Early intervention in psychosis is considered important in relapse prevention. Limited results of monotherapies prompt to development of multimodular programmes. The present study tests feasibility and effectiveness of HIT, an integrative early intervention treatment for auditory hallucinations, in community psychiatry. METHOD: Adolescents with auditory hallucinations consecutively referred to Groningen Voices Outpatient Department. Independent research staff collected diagnosis, sociodemographics, psychiatric history, former treatment and current treatment status from medical files. The auditory Hallucinations Rating Scale, Groningen Social Disabilities Scale and five-point rating scales on characteristics and subjective burden of voices, and satisfaction with therapy were scored with semi-structured interview. RESULTS: Good compliance and high satisfaction with HIT treatment in most cases; 65% free of voices; majority demonstrates substantial improvement on mastery, anxiety, interference with thinking and social functioning; none worsened. CONCLUSION: Integrative treatment as composed in the HIT-programme is feasible in community psychiatry and appears to be an effective early intervention in adolescents with schizophrenia both in reducing psychotic symptoms as improving quality of life.

Adaptation, Psychological↗

PubMed2001

Cognitive behaviour therapy with coping training for persistent auditory hallucinations in schizophrenia: a naturalistic follow-up study of the durability of effects.

OBJECTIVE: To investigate the durability of positive effects of cognitive behaviour therapy (CBT) with coping training on psychotic symptoms and social functioning. METHOD: Forty patients with schizophrenia or related psychotic disorders and refractory auditory hallucinations were given CBT and coping training in an integrated single family treatment programme. In a naturalistic study patients were followed after 2 and 4 years since the start of treatment. RESULTS: The treatment improved overall burden of 'hearing voices', with a generalization into daily functioning. Improvement with regard to fear, loss of control, disturbance of thought and interference with thinking was sustained by 60% of the patients while one-third improved further. Complete disappearance of hallucinations occurred in 18% of the patients. CONCLUSION: CBT with coping training can improve both overall symptomatology and quality of life, even over longer periods of time, but a status of persistent disablement indicates a continuing need for mental health care.

Adaptation, Psychological↗

PubMed2001

Accuracy of general practitioner's prognosis of the 1-year course of depression and generalised anxiety.

BACKGROUND: A prognosis serves important functions for the management of common mental disorders in primary care. AIMS: To establish the accuracy of the general practitioner's (GP) prognosis. METHOD: The agreement between GP prognosis and observed course was determined for 138 cases of ICD-10 depression and 65 of generalised anxiety disorder, identified among consecutive attenders of 18 GPs. RESULTS: Modest agreement between GP prognosis and course was found, both for depression (kappa=0.21) and generalised anxiety (kappa=0.11). Better agreement (kappa=0.45 for depression, and kappa=0.33 for generalised anxiety) was observed between the course and predictions from a statistical model based on information potentially available to the GP at the time the prognosis was made. This model assesses attainable performance for GPs. CONCLUSIONS: General practitioners do a fair job in predicting the 1-year course of depression and generalised anxiety. Even so, their performance falls significantly short of attainable performance.

Adolescent↗

PubMed2000

The construction of the SEDAS: a new suicide-attitude questionnaire.

OBJECTIVE: Only two scales exist for measuring attitudes towards suicidal behaviour. Because of theoretical and methodological limitations of both scales, the SEDAS was constructed to offer an alternative instrument. METHOD: The semantic differential scale, from which the SEDAS was devised, consisted of 36 items (pairs of adjectives) constructed to measure attitudes towards suicidal behaviour of different actors in various situations. It was administered to 142 Dutch SOS-telephone volunteers for seven different actor/situation sets. RESULTS: Item analysis reduced the number of suitable items to 15. Simultaneous component analysis revealed two dimensions on which the actor/situation sets were scored: health/illness and acceptance/rejection, jointly accounting for 47% of variance. Psychometrics of the instrument in terms of internal consistency (values between 0.70 and 0.86), item-rest correlation and test-retest correlation (between 0.63 and 0.87) are acceptable to good. CONCLUSION: The SEDAS may be of value in population surveys, and facilitate effect evaluation of staff training and suicide prevention programmes.

Adolescent↗

PubMed1999

Training primary-care physicians to recognize, diagnose and manage depression: does it improve patient outcomes?

BACKGROUND: We developed a comprehensive, 20-hour training programme for primary-care physicians, that sought to improve their ability to detect, diagnose and manage depression. We evaluated the effects of physician training on patient outcomes, using a pre-post design. METHODS: In the pre-training phase of the study, we sampled 1834 consecutive patients of 17 primary-care physicians and evaluated 518 of these patients for the presence of depression. We measured outcomes of all patients with depression at 3 months and 1 year. The outcome measures were: severity of psychopathology; duration of depressive episode; and level of daily functioning. After the 17 physicians completed the training, we drew a new sample from their practices (498 of 1785 consecutive patients were evaluated for depression) and measured outcomes for the depressed patients. RESULTS: We found an effect of the training on short-term outcome, particularly for patients with a recent-onset depression. At 3-month follow-up depressed patients whose physicians had received training had less severe psychopathology and patients with recent-onset depression also showed higher levels of daily functioning than patients of the same physicians prior to the training. The patients with a recent-onset depression that was recognized by trained physicians had shorter depressive episodes, but this was not statistically significant. At 1-year follow-up, all training effects had faded away. CONCLUSIONS: Training primary-care physicians to recognize, diagnose and manage depression can improve short-term patient outcomes, especially for patients with a recent onset of depression. Patients suffering from a recurrent or chronic depression may need more specific interventions, both for acute treatment and long-term management.

Adult↗

PubMed1998

[Improved recognition and treatment of depression with occasional faster recovery through postgraduate training of family practitioners].

OBJECTIVE: To examine to what extent postgraduate training of general practitioners (GPs) with the Intervention Study Primary Care (INSTEL) programme improved detection, diagnosis, and treatment of depression, and whether the course of depression was influenced favourably. DESIGN: Prospective, comparative. SETTING: Academic Hospital Groningen, discipline group Psychiatry and General Practice, Groningen, the Netherlands. METHOD: General practitioners active in ten practices in Groningen and surrounds were trained in recognition and treatment of depression. The first group consisted of ten GPs who had not participated in psychiatrically oriented research before, the second group of seven GPs who had participated in such research. Both before and after the training, a group of patients aged 18-65 years visiting these GPs' office hours were examined by the investigators for presence of depression with the aid of questionnaires. The GPs recorded of each patient whether or not they found him/her depressed, and they mentioned the treatment. The researchers assessed the outcomes of depressed patients shortly after the index consultation and at 3 and 12-month follow-up. RESULTS: Before the training a questionnaire was completed by 1778 patients, of whom 179 were depressed; after the training a questionnaire was completed by 1724 patients, of whom 155 were depressed. Detection and diagnosis of depression improved in the first group of GPs, but not in the second group. Treatment improved for patients in both groups. In terms of symptoms, illness duration, daily functioning, and absence from work patients recovered slightly faster from their depression after the training, although the effects were weak, not always statistically significant (p < 0.05), and mostly limited to the subgroup of recognized depressions with a recent onset. At the 12-month follow-up the pre-post differences were not statistically significant. CONCLUSION: The postgraduate training with the INSTEL programme appears to be an effective intervention that improves treatment and somewhat speeds up recovery in recent onset cases.

Adolescent↗

PubMed1998

Effectiveness of cognitive therapy with coping training for persistent auditory hallucinations: a retrospective study of attenders of a psychiatric out-patient department.

Recent studies have suggested positive effects of cognitive therapy on psychotic symptoms. However, the effects of coping training are less clear, and generalization to daily functioning has not been attempted for either intervention. A total of 40 patients with therapy-refractory auditory hallucinations received standard care plus cognitive therapy with coping training. In a retrospective, descriptive study, multiple assessments of outcome were measured. The experimental therapy seems to improve both overall symptomatology and quality of life, and is acceptable to both patients and relatives. Generalization to daily functioning and continuation over time was observed. Improvements with regard to the occurrence of hallucinations, fear, disturbance of thought, social interactions and daily activities were significant. Complete disappearance of hallucinations occurred in 20% of participants, and in 40% of those who were regularly discharged from treatment. The level of satisfaction with therapy was high (78%), and the drop-out rate was low (9%). Improvement was not significantly correlated with psychiatric diagnosis (schizophrenia vs. other diagnoses), and was sustained at follow-up after 1 year.

Adaptation, Psychological↗

PubMed1997

Non-verbal behavioral interactions of depressed patients with partners and strangers: the role of behavioral social support and involvement in depression persistence.

Excessive support seeking and lack of receiving social support have been associated with depression onset and unfavorable course of depression. It has been assumed that social support is effected by observable behaviors that express involvement. Twenty-five patients with major depression were studied during a social interaction with their partner and a similar interaction, with a stranger, matched on the sex and age of the partner. We anticipated that (1) partners would display less involvement behaviors to the depressed patients than would strangers and that (2) lack of involvement would predict an unfavorable course of depression, as assessed for depression remission within 6 months of admission. The social interactions, conducted at admission, were videotaped and the behaviors were assessed by ethological methods. The frequency and duration of behavioral elements were associated on the basis of statistical criteria into behavioral factors. Certain factors were supposed to express (lack of) involvement during an interaction. In the patient-partner interaction it was found that both participants displayed lower levels of involvement as compared to the patient-stranger interaction. The patients' low involvement was reflected by less Speech, less Eagerness (yes-nodding and no-shaking), less Speaking Effort (head movements, looking and gesturing during speech) and more Active Listening (intense touching of one's own body and head movements during listening). The partners' low involvement was also expressed by less Speech and more Active Listening, together with less Encouragement (yes-nodding and 'um-hum'-ing during listening). In addition, the partners displayed less Speech to patients who did not remit within 6 months, whereas patients and strangers behaviors were not related to depression remission. These findings supported our anticipations and the findings are related back to data on social support, involvement and to previous human ethological studies on depression.

Adult↗

PubMed1996

Nonverbal interpersonal sensitivity and persistence of depression: perception of emotions in schematic faces.

Deficits in the decoding of facial emotional expressions may play a role in the persistence of depression. In a prospective longitudinal study, 33 depressed outpatients (30 major depression, 2 dysthymia, and 1 cyclothymic disorder) judged schematic faces with respect to the emotions they expressed (fear, happiness, anger, sadness, disgust, surprise, rejection, and invitation) at admission (T0) and again 6 and 30 weeks later. Severity of depression (BDI) was assessed at these three times. Those patients who perceived less sadness, rejection, or anger in faces at T0 were less likely to show a favorable course of depression after 6 weeks (sadness, anger) or after 30 weeks (sadness, rejection, anger). These relationships could not be ascribed to initial levels of depression, age, or gender. The perception of sadness and rejection did not change over time, and therefore may have trait-like qualities. Depression appears to be more persistent in the subgroup that is hyposensitive to (negative) facial signals.

Adult↗

PubMed1996