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PubMed2002

Hospitalization of patients with anorexia nervosa: a therapeutic proposal.

Anorexia nervosa is an eating disorder that primarily affects young women and has a high morbidity and mortality rate. Hospitalization effectively overcomes the acute phase, prevents progression to chronicity and promotes lasting changes. Our aim is to establish a prior therapeutic contract and systematize hospitalization in three stages comprising: clinical and nutritional approaches, individual and group psychotherapy, family therapy, occupational therapy, body therapy and pharmacotherapy. Because of the multiple determination of anorexia nervosa and the risk involved, treatment must be carried out by a multidisciplinary team.

Adult↗
PubMed1990

[The state of professional psychological guidance for patients with multiple sclerosis].

Over a period of two years, a total of 847 patients with multiple sclerosis (283 male and 564 female aged 18 to 79 years) were interviewed relative to the psychological care provided. Two patients currently participated in regular client-centered group therapy, 11 patients had regularly attended individual or group psychotherapy in previous years, and one patient had undergone family therapy several years ago. Another 26 patients reported occasional supportive counselling by their neurologist or family doctor in the framework of outpatient care. Ten patients used relaxation techniques such as autogenic training, and 42 patients reported emotional benefit from contacts within an MS self-help group. The findings of our study show that professional psychological care of persons with MS is extremely sparse, substantiating the call for better psychological services in coping with MS.

Adaptation, Psychological↗
PubMed2002

Remission in major depressive disorder: a comparison of pharmacotherapy, psychotherapy, and control conditions.

OBJECTIVE: The aim of this study was to assess the percentages of full remission in studies of patients with major depressive disorder in which pharmacotherapy, psychotherapy, and control conditions were directly compared. METHOD: Computerized searches of the MEDLINE and PsychINFO databases up to November 2000 were used to identify six multiple-cell randomized, controlled, double-blind trials for well-defined major depressive disorder in which medications, psychotherapy, and control conditions were directly compared and for which remission percentages were reported. RESULTS: The studies included a total of 883 outpatients with mild to moderate, primarily nonmelancholic, nonpsychotic major depressive disorder. Treatment duration ranged from 10 to 34 weeks (median=16 weeks). An intent-to-treat analysis indicated that, according to measurements by independent blind raters, antidepressant medication (tricyclic antidepressants and phenelzine) and psychotherapy (primarily cognitive behavior and interpersonal therapies) were more efficacious than control conditions, but there were no differences between active treatments. The percentages of remission for all patients randomly assigned to medication, psychotherapy, and control conditions were 46.4%, 46.3%, and 24.4%, respectively. Furthermore, significantly more patients dropped out of control conditions (54.4%) than either treatment with medication (37.1%) or psychotherapy (22.2%). CONCLUSIONS: Both antidepressant medication and psychotherapy may be considered first-line treatments for mildly to moderately depressed outpatients.

Adult↗
PubMed2006

Cognitive predictors of response to treatment for depression in multiple sclerosis.

Cognitive impairment, particularly in the domain of executive functioning, has been demonstrated to predict poorer antidepressant medication treatment response. In this investigation, neuropsychological functioning was evaluated as a predictor of depression treatment response among 59 patients with multiple sclerosis. Performance on a Stroop task accounted for 28.7% of the variance in poorer pharmacologic antidepressant treatment response, as compared to less than 1% of the variance in two psychotherapy conditions. These results provide preliminary evidence to suggest that performance on neuropsychological measures may predict antidepressant treatment response in multiple sclerosis.

Adult↗
PubMed2003

Habit reversal versus supportive psychotherapy for Tourette's disorder: a randomized controlled trial.

OBJECTIVE: The authors investigated the efficacy of habit reversal for Tourette's disorder, which is characterized by multiple motor and vocal tics. METHOD: Thirty-two patients with Tourette's disorder were randomly assigned to 14 sessions of either habit reversal or supportive psychotherapy. Habit reversal consisted of awareness training, self-monitoring, relaxation training, competing response training, and contingency management. Changes in severity of Tourette's disorder and psychosocial impairment were investigated over the course of the 14-session treatment for the 29 patients who completed at least eight treatment sessions. RESULTS: In contrast to the 13 patients in the supportive psychotherapy group, the 16 patients in the habit reversal group improved significantly. The habit reversal patients remained significantly improved over pretreatment at 10-month follow-up. CONCLUSIONS: Habit reversal may be an effective behavioral treatment for Tourette's disorder.

Adult↗
PubMed2003

The outcomes of psychotherapy with adolescents: a practitioner-friendly research review.

This article summarizes the outcome findings of psychotherapy with adolescents through an examination of the research literature. In this problem-focused review of the research literature, we consider adolescent treatment of anxiety disorders, depression, eating disorders, disruptive behavior disorders, multiple problems of adolescence, and health risk behaviors. The evidence base for the effectiveness of various psychotherapies for adolescents is mixed. Psychotherapy in general has been a ripe field in which unsupported approaches have grown, and this is certainly true for psychotherapeutic interventions with adolescents. Nonetheless, there is a growing body of evidence to support various types of interventions as effective for different presenting problems. Researchers and clinicians need to recognize the complexity of the diverse characteristics of adolescents, including variations of culture, race, ethnicity, gender, class, physical disability, family definitions and constellation, and sexual orientation. These require sensitivity, responsiveness, and competence by the therapist, but clinical research has not fully examined these considerations.

Adolescent↗
PubMed1996

Predictors of outcome in panic disorder: a 5-year prospective follow-up study.

A prospective 5-year follow-up study in patients with panic disorder was carried out in order to determine predictors of outcome. 50 patients presenting at an outpatient clinic for anxiety disorders were enrolled initially in a controlled treatment study using either imipramine or doxepin in addition to supportive psychotherapy and were then followed under naturalistic treatment conditions. By means of multiple stepwise regression analyses comorbidity with current depression, severity of illness and agoraphobic avoidance turned out to be the strongest predictors. These data confirm the findings of shorter-term prospective follow-up studies and of retrospective studies. In contrast to several reports, illness-related social impairment at baseline was not found to affect outcome.

Adolescent↗
PubMed1980

Treatment of endogenous anxiety with phobic, hysterical, and hypochondriacal symptoms.

Endogenous anxiety (anxiety hysteria, agoraphobia with panic attacks) is characterized by sudden, spontaneous panic attacks accompanied by multiple autonomic symptoms, overwhelming fear, a flight response, and polyphobic behavior. Psychotherapy, behavior therapy, and tranquillizers have been of limited success in treating this syndrome. Fifty-seven patients severely disabled by the syndrome for a mean period of 13 years completed the three-month study. Randomly assigned in a double-blind, placebo-controlled design to imipramine hydrochloride, pheneizine sulfate, or placebo, they were seen in supportive group therapy every two weeks. Patients in the pheneizine and imipramine cells showed significant improvement ovehe persistent trend for pheneizine to be superior to imipramine achieved significance only on the Work and Social Disability Scale and the Sympton Severity and Phobic Avoidance Scale. The implications for classification and theory are discussed.

Adult↗
PubMed2003

The early stage of vascular dementia: significance of a complete therapeutic program.

THEORY: Mild manifestations of vascular dementia are relatively widespread among the old-age population. Drug therapy for this disorder is insufficiently effective at present, making it necessary to improve the treatment of such patients by means of an adequate psychotherapeutic and rehabilitation program. AIMS: To assess the role of psychotherapeutic and rehabilitation measures in improving outcome in the early stage of vascular dementia. METHODS: The test and control cohorts (each n = 95) were matched for characteristics found to be significant for outcome of treatment (the relevant predictors were found using Multiple Regression Analysis). The cohorts differed in the amount of the psychotherapy and rehabilitation received. To assess the effects of treatment the SCAG scale and a special scale for evaluating the level of activity in the household were used. RESULTS: In the test cohort the patients' condition improved significantly compared with the controls. Even in case of only slight therapeutic reduction of psychopathologic symptoms the systematic use of psychotherapeutic and rehabilitation methods favoured preserving a certain level of activity in the household and for some patients even improving it. CONCLUSIONS: The results of therapy at the early stage of vascular dementia to a great extent depend on carrying out a full-scale psychotherapeutic and rehabilitation program. The positive significance of the latter is connected not only with improvement of clinical indices but also with direct optimizing the every day life activity level.

Aged↗
PubMed2006

Changing profiles of service sectors used for mental health care in the United States.

OBJECTIVE: Redesigning the fragmented U.S. mental health care system requires knowing how service sectors share responsibility for individuals' mental health needs. METHOD: Twelve-month DSM-IV mental disorders and their severity were assessed in respondents ages 15-54 from the National Comorbidity Survey (NCS) in 1990-1992 (N=5,388) and the NCS Replication in 2001-2003 (N=4,319). Six profiles involving potentially multiple service sectors were defined, including those in which pharmacotherapy plus psychotherapy (psychiatry profile, general medical with other mental health specialty profile), single modalities (general medical only profile, other mental health specialty only profile), or neither modality (human services only profile, complementary/alternative medicine only profile) could potentially have been received. The use of profiles was compared between surveys. RESULTS: The general medical only profile experienced the largest proportional increase (153%) between surveys and is now the most common profile. The psychiatry profile also increased (29%), as did the general medical with other mental health specialty profile (72%). The other mental health specialty only (-73%), the complementary/alternative medicine only (-132%), and the human services only (-137%) profiles all decreased in use. The elderly, women, minorities, the less educated, and rural dwellers were less likely to use profiles capable of delivering pharmacotherapies and/or psychotherapies. CONCLUSIONS: How service sectors share responsibility for peoples' mental health care is changing, with more care falling to general medical providers rather than specialists. Efforts are required to ensure that people who would benefit have access to the necessary treatment modalities.

Adolescent↗
PubMed2003

[Study of therapeutic community for drug dependence in San Francisco (I)].

Therapeutic Communities (TC) have played an important role in the recovery from drug dependence around the world since the 1960s. They employ multiple and comprehensive methods which include community meeting, life training, psychoeducation, psychotherapy, medical care, and vocational coordination etc. In Japan, there is not such comprehensive rehabilitation programs for drug dependence. In order to learn the programs of TCs, we attend the programs of Walden house and Asian and American Recovery Services (AARS), which San Francisco and rehabilitation programs in Japan and how to introduce the TC methods into Japan.

Humans↗
PubMedDate not supplied

[Effectiveness of psychotherapy in asthma: meta-analysis].

Various works have been done to find the efficiency of different psychotherapies of asthma. The results are sceptical and sometimes contradictory; this contradiction probably is due to the multiple methods or also to the various variables linked to the illness. The results of our meta-analyses on 74 hypotheses chosen by specific criteria show the efficiencies of all these psychotherapies in asthma; however, these results are largely dependent on the 8 variables taken into account.

Asthma↗
PubMed1998

Relationship between interpersonal psychotherapy problem areas with temperament and character: a pilot study.

OBJECTIVE: To examine the relationships between dimensions of personality assessed by using the Temperament and Character Inventory and presenting problem areas in Interpersonal Psychotherapy. METHOD: One hundred two depressed patients completed the Temperament and Character Inventory (TCI), and Interpersonal Psychotherapy (IPT) problem areas were assessed using a clinician-rated questionnaire. RESULTS: Following multiple regression analysis, patients rated as having problems with grief scored low on self transcendence, those with disputes had low cooperativeness, those with role transitions had low novelty seeking, and those with deficits had low reward dependence. CONCLUSIONS: Both temperament and character may be relevant to the nature of presenting problems related to Interpersonal Psychotherapy. An understanding of how personality is relevant to presenting interpersonal problems may provide both a framework and a focus with which to work in this form of psychotherapy.

Adult↗
PubMed2006

Psychological interventions for multiple sclerosis.

BACKGROUND: The unpredictable, variable nature of Multiple Sclerosis (MS), and the possibility of increasing disability, means that a diagnosis can have substantial psychological consequences. OBJECTIVES: To assess the effectiveness of psychological interventions for people with MS. SEARCH STRATEGY: We searched 19 databases up to December 2004; Cochrane MS Group Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, PsychINFO, CINAHL and 14 others. We searched reference lists of articles, wrote to corresponding authors of the 13 papers identified by June 2004, and searched for trials in progress using 3 research registers. SELECTION CRITERIA: Randomised controlled trials of interventions described as wholly or mostly based on psychological theory and practice, in people with MS. Primary outcome measures were disease specific and general quality of life, psychiatric symptoms, psychological functioning, disability, and cognitive outcomes. Secondary outcome measures were number of relapses, pain, fatigue, health care utilisation, changes in medication, and adherence to other therapies. DATA COLLECTION AND ANALYSIS: Pertinent studies were identified from abstracts by one author. Full papers were independently compared to selection criteria by four authors. Key details were extracted from relevant papers using a standard format, and studies scored on three dimensions of quality. The review is organised into four mini-reviews (MR) dependent on the intervention's target population; people with cognitive impairments (MR1), people with moderate to severe disability (MR2), people with MS (no other criteria) (MR3), and people with depression (MR4). MAIN RESULTS: Overall 16 studies were identified and included. MR1: three trials (n=145). Some evidence of effectiveness of cognitive rehabilitation on cognitive outcomes, although this was difficult to interpret because of the large number of outcome measures used. MR2: three trials (n=80). One small trial suggesting psychotherapy may help with depression. MR3: seven studies (n=688). Some evidence that cognitive behavioural therapy may help people adjust to, and cope with, having MS (three trials). The other trials were diverse in nature and some difficult to interpret because of multiple outcome measures. MR4: three trials (n=93). Two small studies of cognitive behavioural therapy showed significant improvements in depression. AUTHORS' CONCLUSIONS: The diversity of psychological interventions identified indicates the many ways in which they can potentially help people with MS. No definite conclusions can be made from this review. However there is reasonable evidence that cognitive behavioural approaches are beneficial in the treatment of depression, and in helping people adjust to, and cope with, having MS.

Adaptation, Psychological↗
PubMed2003

E-mail as an adjunctive tool in psychotherapy: response and responsibility.

In a world of technological breakthroughs, it is not surprising that psychotherapists have, along with the general population, taken to the multiple possibilities offered by devices or systems that affect communication. E-mail, now an ever-present phenomenon of near "real time" interaction, provides a myriad of possibilities for enhanced dialogue in psychotherapy relationships. This paper will describe the growing phenomenon of e-mail as an adjunctive tool in psychotherapy practice by initially reviewing the most current of the recent literature. The authors will present a model for the adjunctive use of e-mail between patient and therapist. Case material will illustrate this model as applied to ongoing treatment, crisis intervention, and follow-up.

Adult↗
PubMed2000

The therapeutic alliance in couples and family therapy.

The therapeutic alliance is central to couples and family therapy. Although the formal concept of therapeutic alliance has not been used widely within the family therapy field, virtually every prominent clinical theorist has addressed the importance of establishing and maintaining a positive therapeutic relationship with the family. The alliance in couples and family treatment differs from the alliance in individual psychotherapy in that the couples and family therapist must establish and maintain multiple alliances. They also must adopt a conceptual framework that accounts for the interactions within triangles or three-person systems, recognize the influence of the system operating on him or her, and appreciate how different models of family therapy define the position of the therapist in relation to the couple or family. An integrative review of the therapeutic alliance in couples and family therapy is followed by a discussion of problems in the therapeutic relationship. Two general clinical strategies for managing difficulties in the alliance then are illustrated through case vignettes.

Adult↗
PubMed2000

Psychiatric issues in medical-surgical disaster casualties: a consultation-liaison approach.

Psychiatrists can increase the efficacy of their response to disaster victims in the immediate aftermath of a disaster if they utilize a consultation-liaison approach to assessment and management of casualties. Medical-surgical disaster responders use an algorithmic, stepwise approach to assess disaster or trauma victims. This approach ensures that patients with life-threatening injuries who are not expectant are treated first. Then, secondary physical assessments ensure proper triage of other victims so that disaster response resources are used most wisely. A tertiary psychiatric assessment can assist with differential diagnosis of post-disaster neuropsychiatric symptoms and signs to ensure valuable medical-surgical resources are targeted to the correct patients. Psychiatric triage can also identify those victims most in need of early preventive and therapeutic psychiatric intervention.

Disaster Planning↗