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At least 793 records · Page 44Linked to original sources
PubMed1992

Severity of unipolar depression and choice of treatment.

The National Institute of Mental Health (NIMH) Treatment of Depression Collaborative Research Program (Elkin et al., Archives of General Psychiatry, 46, 971-982; 1989) reported treatment-by-severity interactions favouring pharmacotherapy for more depressed outpatients, on a minority of relevant comparisons. The present study reports secondary analyses from a similar, preexisting data set in which treatment-by-severity interactions are systematically investigated with depressed outpatients treated either with nondirective psychotherapy, behaviour therapy, pharmacotherapy, or relaxation/placebo. Despite multiple severity measures and variable severity cut scores, no treatment was differentially effective in improving more severely depressed patients. Also, there was little difference across symptom severity levels in the proportions of recovered patients between treatment groups. Finally, dynamic cluster analysis demonstrated that the proportion of pharmacotherapy nonresponders (20%) did not differ from the proportion of nonresponders in behaviour therapy or placebo groups. It is concluded that this failure to replicate the NIMH trial findings can not be attributed to treatment differences, populations or statistical power. The suggestion that pharmacotherapy be the treatment of choice for more severely depressed outpatients appears to be unjustified on the basis of available evidence.

Adult↗
PubMed2002

Inpatient psychotherapy compared with usual care for patients who have schizophrenic psychoses.

The study examined whether some patients with schizophrenia benefit from intensive inpatient psychodynamic psychotherapy while others are harmed by it. Multiple regression analyses were conducted with combined data from a follow-up study of 25 inpatients who were treated in a psychotherapeutic program and a follow-up study of 71 patients who received standard hospital treatment. The mean duration of the follow-up period was seven years. The analyses showed that improvement in global mental health status from the index admission to follow-up was associated with the type of treatment and with the patient's clinical condition at the index admission. A strong interaction effect was found between these two variables. Psychotherapeutic inpatient programs may be beneficial to patients who have higher levels of global functioning at the start of treatment but detrimental to other patients.

Follow-Up Studies↗
PubMed1999

Diagnosis, management, and treatment of Alzheimer disease: a guide for the internist.

Alzheimer disease (AD) is a diagnosis of inclusion based on patient history, physical examination, neuropsychological testing, and laboratory studies; however, there is no definitive diagnostic test for AD. Early recognition of AD allows time to plan for the future and to treat patients before marked deterioration occurs. Effective treatment requires monitoring of symptoms, functional impairment, and safety, and the use of multiple treatment modalities including pharmacotherapy, behavioral management, psychotherapies, psychosocial treatments, and support and education for families. Pharmacotherapeutic agents available for AD only provide symptomatic relief. The cholinesterase inhibitors, tacrine and donepezil, are effective in improving cognition, delaying nursing home placement, and improving behavioral complications in some patients. Other cholinesterase inhibitors are in development, as are other cholinomimetic agents such as muscarinic and nicotinic receptor agonists. Symptomatic treatments are available for the psychiatric manifestations of AD. Anti-inflammatories, antioxidants, neurotrophic factors, and other agents are promising new treatments for the future.

Alzheimer Disease↗
PubMed2004

Multimodal treatment for ADHD among youths in three Medicaid subgroups: disabled, foster care, and low income.

OBJECTIVE: This study compared the use of treatments for attention-deficit hyperactivity disorder (ADHD) among three distinct subpopulations of Medicaid-insured youths who have very different mental health needs and patterns of service use: those with federally documented disability, those in foster care, and those in families with low income. METHODS: This one-year, cross-sectional study of community mental health services used administrative data. Individuals who were younger than 20 years, who were continuously enrolled in one Mid-Atlantic state Medicaid program, and who had two or more medical encounters associated with an ADHD diagnosis in 1998 were identified (N=1,296). Measures of the use of mental health services were the number of different classes of psychopharmacologic medications, the psychopharmacologic regimen, and the combined use of pharmacotherapy and psychotherapy treatments (multimodal treatment). RESULTS: Use of multiple psychopharmacologic agents was greater in the disabled and foster care groups compared with the low-income group. Significantly fewer mental health provider visits, but greater use of stimulant treatment only, were observed in the low-income group compared with the other groups. Youths in the disabled group were significantly more likely than youths in the low-income group, but not more likely than youths in the foster care group, to receive multimodal treatments. Children in foster care were significantly more likely than those in the other groups to use a substance abuse service. CONCLUSIONS: Among a cohort of Medicaid-enrolled youths with ADHD, co-existing psychiatric disorders and complex psychopharmacologic treatments were more common in the disabled and foster care groups than in the low-income group. Youths with disabilities were significantly more likely than youths in the low-income group to receive multimodal treatment.

Adolescent↗
PubMed1988

Techniques in the treatment of multiple personality disorder.

Multiple personality disorder, once considered to be rare, is being diagnosed with increasing frequency in the 1980s. The purpose of this paper is to present and discuss twenty techniques used in the treatment of multiple personality disorder. The primary treatment is psychotherapy but a number of adjuvant interventions are also required. The techniques discussed should be of use to therapists and represent a step towards definition of a treatment package for controlled trials, of which none have been conducted to date.

Abreaction↗
PubMed2004

Walking the tightrope: developing an attachment-based/relational curriculum for trainee psychotherapists.

I describe how the Centre for Attachment-based Psychoanalytic Psychotherapy (CAPP) in London has gone about developing an attachment-based/relational curriculum for training psychotherapists. A key problem the training is meant to address is how to maintain a balance between enabling students to absorb research and clinical knowledge of psychological processes at the same time as they learn to maintain the flexibility necessary to address the uniqueness of each individual encounter in the consulting room. I describe the task of the training in terms of a linguistic metaphor: the training needs to ensure that students are theoretically multi-lingual while developing higher levels of fluency in the language of attachment-based/relational psychotherapy. In the pursuit of this approach, my colleagues and I developed a set of ten key propositions - the spine of the relational world - which we felt encapsulated the main theoretical assumptions of attachment-based practice that students need to understand and explore. This has been used to evolve a spiral curriculum, designed to help students engage constructively with the often confusing emotional aspects of clinical work, and with the multiplicity of clinical viewpoints that characterises contemporary psychoanalytic psychotherapy.

Curriculum↗
PubMed1996

The effects of imagery on attitudes and moods in multiple sclerosis patients.

OBJECTIVE: To determine the efficacy of imagery for influencing attitudes and moods in multiple sclerosis patients. DESIGN: Experimental pretest-posttest, control-group. SETTING: Outpatient group in Central Pennsylvania. PATIENTS: 33 patients with mean ages of 43.93 years in the imagery group and 46.33 years in the control group. All subjects previously were identified with multiple sclerosis. INTERVENTION: Control group subjects followed their typical medical protocol and completed pretest and posttest measures. Imagery group subjects completed pretest and posttest measures and participated in a six-session group process that included brief exposure to relaxation training and ongoing work with biologically oriented imagery. Relaxation training and imagery were practiced on a daily basis. Imagery group subjects also produced imagery drawings, which were assessed after the third and sixth sessions. MAIN OUTCOME MEASURES: Profile of Mood States, State-Trait Anxiety Inventory, Health Attribution Test, Imagery Assessment Tool, and Multiple Sclerosis Symptom Checklist. MAIN RESULTS: Imagery group subjects demonstrated significant reductions in state anxiety and significant alteration in their illness imagery because of feedback obtained during the study. CONCLUSION: Use of the relaxation/imagery protocol led to clinically significant reductions in state anxiety. Imagery may be assessed through drawings that allow for positive modification of the imagery material to increase its utility and power.

Adult↗
PubMed1976

Method factors associated with assessment of child behavior: fact or artifact?

A sample of 64 phobic children between the ages of 6 and 16, with their general population matched controls, were rated by parents on the Louisville Behavior Check List and Louisville Fear survey and by School Behavior check list. The analysis of ratings by factor analysis revealed three instrument factors while a multiple discriminant analysis elicited a multidimensional phobic trait that crossed observers, situations, and instruments. The results are discussed in terms of the implications for multivariant analysis of behavior change as well as for classification of psychopathological disorders of childhood. The thesis is advanced that instrument factors elicited by factor analysis in psychotherapy change studies are statistical artifacts and that a multiple discriminant analysis is a more appropriate technique for the study of change as well as for classification.

Adolescent↗
PubMed1992

Psychotherapy: past training and current practice.

Our 1988 survey of Texas psychiatrists indicates that hospital work is more common, and long-term psychotherapy less common than it had been in the 1982 APA survey. Almost 85% reported long-term psychotherapy experience as residents. Thirty-nine percent reported multiple patients treated for approximately 2 years. Use of audio techniques by resident and teacher in the post-1970-trained group predicted current long-term therapy activity as did an experience of personal therapy and seeing a patient at least twice weekly in training. Concurrent drug use is widely reported for long-term psychotherapy patients and to a lesser degree in psychoanalysis. Our data suggest a shift to increased hospital work and decreased long-term psychotherapy.

Attitude of Health Personnel↗
PubMed1986

[Psychiatric emergencies].

The present work is divided into four parts, the first part is a brief "Discourse on Emergency" that attempts to clarify the elements that distinguish psychiatric from medical emergency. The second part reviews the "Clinical pictures in which psychiatric emergency is not common". Psychopathological emergencies are briefly reviewed and mention is made of psychiatric emergencies deriving from non-psychiatric pathologies. The third part gives "Advice on the right approach to adopt in response to calls". Some integrated approaches are suggested. The fourth part presents several models of "Short-term psychotherapy in psychiatric emergency". Two cases of emergency treatment using multiple approach techniques are reported.

Adolescent↗
PubMed1981

Multiple family therapy and naltrexone in the treatment of opiate dependence.

The effect of multiple family therapy on client compliance and retention in a high intervention, naltrexone treatment program was examined retrospectively. The population consisted of 65 opiate-dependent individuals consecutively treated with naltrexone and a standard program of counseling and supportive psychotherapy. Twenty-five of these individuals, in addition, received multiple family therapy. The data presented are suggestive of the efficacy of combining multiple family therapy and high intervention in patients being treated with naltrexone. Analysis of the data demonstrated that the group receiving multiple family therapy had a larger continuous time of naltrexone ingestion and remained in the treatment program longer than clients who did not receive multiple family therapy. These effects were independent of race and employment status. The implication of the results for treatment and avenues for future research are discussed.

Adolescent↗
PubMed1996

Feminist psychodynamic psychotherapy of eating disorders. Theoretic integration informing clinical practice.

Ideas derived from feminism and psychoanalytic theory can be combined for the integrated treatment of eating disorder patients. For a large subgroup of patients who continue to have a poor quality of life or inadequate symptom control (despite customary psychopharmacologic and cognitive behavioral interventions), feminist psychodynamic psychotherapy may prove lifesaving. This article explores how the patient may come to grasp more deeply the multiple roles her symptom has played in her psychological survival. Practical suggestions to enrich the psychotherapy as the patient traverses the natural struggles of adult life are emphasized. The importance of understanding and working with transference and countertransference issues while helping the patient accept life's paradoxes, ambiguities, and potential avenues for growth are underscored. The author reviews eight specific areas that warrant attention in psychotherapeutic exploration from a feminist psychoanalytic perspective (Culture as Bedrock Issue; Gender as Organizer of Behavior, Ownership of Body; Moral Development; Development of Personal Voice; Emphasis on Adult Development; Sexual Concerns; and Aggressive Conflicts).

Culture↗
PubMed1981

Psychotherapy with depressed outpatients: patient and process variables as predictors of outcome.

This paper evaluates the predictive power of two classes of variables which are thought to be related to psychotherapy outcome: patient characteristics assessed at the start of treatment, and process characteristics of the psychotherapy. The treatment was Short Term Interpersonal Psychotherapy which was performed with ambulatory patients during a major depressive episode as defined by Research Diagnostic Criteria. Univariate correlations indicate that patients with generally healthier functioning on the Prognostic Index received better ratings on measures of psychotherapy process and experienced greater improvement in depressive symptoms and social functioning. However, in a multiple regression analysis, patient characteristics accounted for 64 per cent of the variance in treatment outcome, while psychotherapy process variables were not predictive of outcome.

Adolescent↗
PubMed1987

The spectrum of depression in multiple sclerosis. An approach for clinical management.

Twenty patients with clinically definite multiple sclerosis who experienced major depressive episodes according to Research Diagnostic Criteria are described. The heterogeneous quality of these depressive episodes is presented by categorizing the episodes according to ten Research Diagnostic Criteria depressive subtypes. Four interpersonal management strategies for such patients that are applicable within a neurologic practice setting are described. The most important feature concerning prognosis for these depressive episodes appears to be the relationship between the depressive episode and the underlying demyelinating disease. When depression occurred in the setting of clinically significant disease activity, the outcome was usually favorable.

Adult↗
PubMed2006

[Functional gastrointestinal disorders].

The functional gastrointestinal disorders (FGID) are the most frequent clinical conditions seen in practice. The FGID are associated with significant work absenteeism, impaired quality of life and increased medical costs. Most patients also suffer from psychosocial problems. Therefore it is important to define the patient's complaints in terms of a biopsychosocial disorder rather than just a medical illness. Physicians must acknowledge the relevance of the psychosocial aspects to prepare the patient for a referral to a specialist (in psychosomatic medicine or a psychotherapist) and to get the patient interested in the psychological factors involved as well as further explore their cause. Most of the research on psychotherapy in FGID to date has focused on the irritable bowel syndrome, and different methods of treatments have been studied (e. g., cognitive-behavioral therapy, dynamic psychotherapy, hypnotherapy, and relaxation). Randomised controlled studies have shown that psychotherapy is superior to conventional medical therapy. Hypnotherapy seems to be very successful. Predictors of a positive response to psychological treatment generally are: (1) awareness that stress exacerbates their bowel symptoms, (2) mild anxiety or depression, (3) the predominant bowel symptom is abdominal pain or diarrhea and not constipation, (4) the abdominal pain waxes and wanes in response to eating, defecation, or stress rather than being constant pain, and (5) the symptoms are of relatively short duration. Psychotherapy is initially relatively expensive because it requires multiple, long sessions. However, its benefits persist or even increase over time, and in the long run, there may be a reduction in clinic visits and health care costs which offsets the initial cost of psychological treatment.

Cognitive Behavioral Therapy↗
PubMed1992

Psychological responses of rescue workers: fire fighters and trauma.

The psychological responses of two groups of fire fighters were examined following the performance of rescue work. Four types of responses were reported: identification with the victims, feelings of helplessness and guilt, fear of the unknown, and physiological reactions. Stress was found to be mediated by availability of social support, type of leadership, level of training, and use of rituals. Implications of these findings for preventive intervention measures are discussed.

Accidents, Aviation↗
PubMed1993

Effects of neuropsychological treatment in patients with multiple sclerosis.

The chronic and progressive nature of multiple sclerosis (MS) often excludes patients from neuropsychological treatment. At the Multiple Sclerosis Rehabilitation Hospital, Haslev, 40 patients with mild to moderate cognitive and behavioral impairment associated with MS were randomized to either specific cognitive treatment (20 pts) by direct training, compensatory strategies and neuropsychotherapy, or to non-specific, deliberately diffuse mental stimulation (20 pts). Treatment was for a mean of 46 days. The effects of treatment were evaluated by neuropsychological tests before treatment, immediately after treatment (short-term effects) and 6 months later (long-term effects). After short-term treatment, effects on cognitive measures were not convincing, but on the Beck Depression Inventory (BDI) the specific cognitive treatment group reported significantly less depression. After 6 months only this group showed an effect, since the visuo-spatial memory was improved. However, the depression ratings (BDI) were almost maintained from the short-term level. Interestingly, the non-specific treatment group rated themselves as significantly more depressed. Conclusively, it is worth while to offer specific neuropsychological treatment to MS patients with cognitive and behavioral dysfunction.

Adult↗