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PubMed2003

Effects of psychological group therapy in patients with multiple sclerosis.

OBJECTIVES: The aim of this pilot study was to evaluate a psychological therapy program used in the treatment of multiple sclerosis (MS) and including cognitive/behavioral strategies, relaxation training and physical exercise. MATERIAL AND METHODS: The participants were 29 patients with MS recruited from an outpatient unit; 14 patients were assigned to the 7-week psychological therapy group (one session per week), the remainder formed a control group. Before and immediately after the course of therapy and after a 2-month follow-up, the participants completed a series of questionnaires measuring factors such as depression, anxiety, coping and body image. RESULTS: Compared with the control group the therapy group showed long-term improvements in depressive stress coping style and a short-term improvement in "vitality and body dynamics". CONCLUSION: Further studies should investigate the differential effects of specific units of the therapy program and how the short-term improvements in "vitality and body dynamics" could be maintained for longer periods.

Adult↗
PubMed1999

Long-term results and quality of life after parasuicidal multiple blunt trauma.

OBJECTIVE: This study evaluates the somatic, socioeconomic, and psychiatric long-term results, as well as the factors for adverse outcome, in a significant subset of patients with severe multiple injuries resulting from attempted suicide. DESIGN: The follow-up study 6.1 +/- 3 (SD) yrs after trauma was based on prospectively documented data of patients with multiple injuries. SETTING: Level I university trauma center in a major German city. MEASUREMENTS AND MAIN RESULTS: Data derived from thorough physical and psychiatric evaluations. The Brief Psychiatric Rating Scale and the Global Assessment of Functioning Scale served to describe psychiatric outcome. PATIENTS: In a series of 539 severely injured patients (Abbreviated Injury Score in two regions > or = 3), 65 (12%) attempted suicides were reported (Injury Severity Score, 40 +/- 15; age, 38 +/- 18 yrs). Twenty-one patients of the study cohort died during the hospital stay, and six subjects died thereafter, none because of suicide. Three patients were lost to follow-up, resulting in 35 individuals eligible for examination. None of the latter had reattempted suicide. Seventeen (48%) had good or satisfactory outcomes reflected by absent or ambulatory psychiatric treatment, employment, normal psychiatric findings (Brief Psychiatric Rating Scale), and good psychosocial ability (Global Assessment of Functioning Scale). For eight patients (24%), the result was indeterminate. The adverse outcomes in ten patients (28%) were mainly influenced by the presence of chronic schizophrenia (n = 4), affective disorder (n = 2), or severe traumatic brain injury (n = 3). CONCLUSIONS: Despite the parasuicidal origin, the long-term results after severe trauma were good or satisfactory in approximately half the cases and without further suicide attempts in any of the patients. Good recovery of the parasuicidal patients in our study is approximately 20% lower than in an unselected group of patients with multiple injuries and may be attributed mainly to the underlying chronic psychiatric disease.

Adult↗
PubMed1992

Measuring the determinants of work values for psychiatrists' services in the resource-based relative value scale study.

OBJECTIVE: As part of the Harvard resource-based relative value scale study, the authors investigated how well the codes in the Physician's Current Procedural Terminology, 4th edition, or CPT-4, match psychiatric services to the work involved in evaluating and managing patients and how patient care characteristics affect different levels of psychiatric work. METHOD: A random sample of over 200 psychiatrists and subspecialists was asked to use 68 typical clinical examples or vignettes to evaluate services described by CPT codes. Data were analyzed by multivariate statistical methods. RESULTS: The survey showed that the existing coding system does not adequately describe the work that psychiatrists do. Within a single code (e.g., 90844, individual medical psychotherapy), there was wide (more than twofold) variation in the estimates, from multiple measurements based on different vignettes, of the amount of work represented. Estimates of work values varied significantly according to treatment setting and patient characteristics: psychiatric services in the hospital showed an average work value 25% greater than that for office services; treating new patients involved 18% more effort than treating established patients; and treating patients described as at risk of harming self or others increased the psychiatrists' work effort by 36%. CONCLUSIONS: Revisions in coding evaluation and management services in the new Medicare fee schedule for psychiatric services should be further refined and then implemented. These revisions would bring the coding system into line with psychiatric practice, making it a better way of accounting for the relative work involved in treating patients of varying difficulty.

Fee Schedules↗
PubMed1991

Psychosocial needs of torture survivors.

Growing recognition that the world faces a modern epidemic of torture has stimulated widespread interest amongst mental health professionals in strategies for the treatment of survivors. In this article we outline the distinctive experiences of torture survivors who present for treatment in western countries. These survivors are usually refugees who, in addition to torture, have suffered a sequence of traumatic experiences and face ongoing linguistic, occupational, financial, educational and cultural obstacles in their country of resettlement. Their multiple needs call into question whether "working through" their trauma stories in psychotherapy will on its own ensure successful psychosocial rehabilitation. Drawing on our experience at a recently established service, we propose a broader therapeutic aim.

Adaptation, Psychological↗
PubMed1990

[Experiences with psychosocial management of patients with multiple sclerosis in a discussion group].

Patients with multiple sclerosis must come to terms with their unpredictable chronic disease. Frequently, they want to establish contacts and exchange information with others sharing the same problems. Discussion groups of outpatients offer many opportunities to further the process of coping with the disease as an interlocking web of defensive and coping patterns. The patients can learn from each other to assess their disabilities and capabilities more realistically and to deal more openly with their fears, hopes and disappointments.

Adaptation, Psychological↗
PubMed1994

Countertransference issues when the therapist is ill or disabled.

Multiple external life events and vicissitudes can impinge upon the traditional privacy and isolation of the usual psychotherapy situation and relationship. Among these are major illness and disability in the therapist, which will activate conscious and unconscious responses in both patient and therapist. If worked with and well handled by the participants, such events may stimulate therapeutic growth and working through of multiple issues related to illness, separation, death, anxiety, and fantasies of omnipotence and idealization. However, multiple factors in both patient and therapist may combine to foster avoidance of the conflicts that have been activated. To the extent that countertransference responses in the therapist interfere with his/her ability to bring conscious attention to these issues, a potentially valuable therapeutic opportunity may be lost. It is important for therapists to therapists to anticipate such situations, and to make use of colleague consultation to assist in managing them.

Chronic Disease↗
PubMed2003

A four-year study of enhancing outpatient psychotherapy in managed care.

OBJECTIVES: This study was a first step in explicitly attempting to open, at least partially, the "black box" of specialty managed mental health care by examining qualitative as well as quantitative aspects of managed outpatient mental health treatment. The Goal Focus Treatment Planning and Outcomes (GFTPO) program was studied as an example of a relatively simple, patient-specific, structured educational intervention with a modest capacity to affect practice patterns and care over time among network clinicians. METHODS: Four years of data from an enhanced care management program (N=28,741) designed to facilitate focused, goal-oriented, accountable outpatient psychotherapy and appropriate use of medications were used to illustrate what was actually done in one large national managed behavioral health organization. Random samples of persons from seven matched pairs of GFTPO (N=17,752) and non-GFTPO (N=10,989) employer groups from 1995 to 1998 were studied in a quasi-experimental design. The effects of GFTPO were tested by analyzing samples compared on five measures of outpatient psychotherapy: errors in prescribing medication, continuity of therapists, early termination of treatment, likelihood of multiple treatment episodes, and the use and cost of services. RESULTS: The GFTPO sample showed a lower incidence of medication prescribing errors and therapist switching as well as shorter treatment episodes in the year after the start of outpatient treatment. No differences were observed in the likelihood of early termination or of having multiple treatment episodes. Cost savings did not appear to be at the expense of quality of care. CONCLUSIONS: It is possible to enhance the potential for measuring and influencing the quality of care in large organized systems.

Adolescent↗
PubMed1999

[The rehabilitative treatment of victims with multiple and combined trauma].

Traditional methods of rehabilitation period treatment are not always possible with poly-trauma patients due to the presence of several fractures in association with internal injuries, bed-rest regime, hypokinesia of long duration and other factors. The author offers a complex approach to treatment with the provision for individual state of the patient. A consistent and gradual application of individual rehabilitation programmes together with physiotherapy, physical exercises, acupuncture, reflexotherapy and psychotherapy often helped to obtain good results.

Abdominal Injuries↗
PubMed1984

Spontaneous hypnotic age regression: case report.

Age regression--reliving the past as though it were occurring in the present, with age appropriate vocabulary, mental content, and affect--can occur with instruction in highly hypnotizable individuals, but has rarely been reported to occur spontaneously, especially as a primary symptom. The psychiatric presentation and treatment of a 16-year-old girl with spontaneous age regressions accessible and controllable with hypnosis and psychotherapy are described. Areas of overlap and divergence between this patient's symptoms and those found in patients with hysterical fugue and multiple personality syndrome are also discussed.

Adolescent↗
PubMed1997

Modeling psychotherapy outcome as event in time: an application of multistate analysis.

Standard survival analysis (SA) and multistate analysis (MSA) are methods for modeling categorical psychotherapy outcome events over time. The underlying principles, mathematical details, and indications for using each technique are discussed, and data from an anorexia nervosa psychotherapy outcome study comparing psychodynamic psychotherapy with psychodynamic psychotherapy plus cognitive-behavioral techniques are used to illustrate the use of SA and MSA techniques. MSA includes multiple competing outcome states in a single model. A single MSA model includes reaching target weight and treatment dropout before reaching target weight as competing events. It is concluded that MSA is an informative analytic technique in the domain of psychotherapy research.

Adult↗
PubMed2005

Treatment for depression and its relationship to improvement in quality of life and psychological well-being in multiple sclerosis patients.

Depression, a common problem in multiple sclerosis (MS), is generally associated with poorer quality of life (QOL). However, it is unclear whether treating depression also extends to better perceived QOL. Understanding QOL in MS has been limited by narrow definitions and exclusive focus on symptomology, with little emphasis on positive aspects of QOL. This study examined the impact of treating depression on QOL in 60 patients with a relapsing form of MS and moderate to severe depression, who were randomly assigned to one of three validated 16-week treatments for depression: individual cognitive-behavioral therapy, group psychotherapy, or sertraline. QOL was measured by the MSQOL-54, a version of the SF-36 adapted for MS, and Ryff's scales of psychological well-being, which measure positive attitudes and functioning. Depression and QOL were measured at baseline and immediately following treatment completion. Controlling for baseline neurological impairment and baseline QOL scores, regression analyses showed treating depression was significantly associated with improvements in the MSQOL-54 scales (R2s = 0.19-0.55, p < 0.001) and in four of the six scales of psychological well-being: environmental mastery (R2 = 0.13, p < 0.001), positive relations (R2 = 0.08, p < 0.001), purpose in life (R2 = 0.16, p < 0.001), and self-acceptance (R2 = 0.26, p < 0.001). Findings suggest treating depression influences both the negative and positive aspects of QOL and underscore the importance of examining QOL with two complementary approaches.

Adult↗
PubMed1989

Prescription of psychotropics to children in office-based practice.

Multiple authors have stressed the need for close follow-up and simultaneous psychotherapy in most children treated with psychotropic drugs. However, little is known about the actual prescription of psychotropic medications in pediatric settings. Using the 1985 National Ambulatory Medical Care Survey, we investigated the frequency of follow-up arrangements and concurrent psychotherapy among US children in visits to office-based practices. We then explored determinants of psychotropic drug prescriptions. Mental health indicators, sociodemographic characteristics, provider type, and provider familiarity with the patient were important predictors of psychotropic prescriptions. Few providers report referral or concurrent psychotherapy for their patients receiving psychotropics, and follow-up plans were no different for children with or without psychotropics after controlling for other variables. This means that many children in outpatient care who are taking psychotropic medications may not be receiving optimal management for behavioral or emotional problems.

Adolescent↗
PubMed1986

The logistic regression analysis of psychiatric data.

Logistic regression is presented as the statistical method of choice for analyzing the effects of independent variables on a binary dependent variable in terms of the probability of being in one of its two categories vs the other. The method, which must be applied by computer, is illustrated on data from the DSM-III field trials. The dependent variable is treatment with behaviourally-oriented psychotherapy vs treatment with psychoanalytically-oriented psychotherapy, and the independent variables are several patient and clinician characteristics. Like ordinary multiple regression, the method is shown capable of analyzing categorical as well as continuous independent variables. Unlike ordinary multiple regression when applied to binary data, logistic regression analysis necessarily yields estimated probabilities that lie between 0 and 1. The measure of association derived from logistic regression analysis, the odds ratio, is defined. Methods for making inferences about it are presented and illustrated.

Attitude of Health Personnel↗
PubMed2005

Does psychological treatment help only those patients with severe irritable bowel syndrome who also have a concurrent psychiatric disorder?

OBJECTIVE: We have previously reported improved health-related quality of life in patients with severe irritable bowel syndrome (IBS) following psychological treatments. In this paper, we examine whether this improvement was associated with improvement in psychological symptoms and was confined to those patients who had concurrent psychiatric disorder. METHOD: Two hundred and fifty-seven patients with severe IBS entering a psychological treatment trial were interviewed using the Schedules for Clinical Assessment in Neuropsychiatry. At entry to the trial and 15 months later, patients were also assessed using the Hamilton Depression Rating Scale, Symptom Cheecklist-90 (SCL-90) and Short Form-36 (SF36) physical component summary score as the main outcome measure. Partial correlation was used to compare changes in SF36 score and changes in psychological scores while controlling for possible confounders, treatment group and baseline scores. Multiple regression analysis was used to examine whether changes in psychological scores, changes in pain and a history of abuse could account for most of the variance of change in SF36 physical component score. RESULTS: Of 257 patients with severe IBS, 107 (42%) had a depressive, panic or generalized anxiety disorder at trial entry. There were moderate but significant correlations (0.21-0.47) between change in the psychological scores and the change in SF36 physical component scores. The correlation coefficients were similar in the groups with and without psychiatric disorder. The superiority of psychotherapy and antidepressant groups over treatment as usual was similar in those with and without psychiatric disorder. Multiple regression found significant independent effects of change in depression, anxiety, somatization and abdominal pain but there was still variance explained by treatment group. CONCLUSIONS: In severe IBS improvement in health-related quality of life following psychotherapy or antidepressants is correlated with, but not explained fully by reduction of psychological scores. A more complete understanding of how these treatments help patients with medically unexplained symptoms will enable us to refine them further.

Adult↗
PubMed1998

Conducting exposure treatment in multiple contexts can prevent relapse.

The acquisition of anxiety disorders (e.g., phobias) is often thought to be mediated by classical conditioning processes (e.g., Wolpe, 1958, Psychotherapy by reciprocal inhibition Wolpe and Rowan, 1989, Behaviour Research and Therapy, 27, 583-585). Thus, the success of exposure therapy is possibly a consequence of extinction, and factors affecting extinction in Pavlovian conditioning are potentially relevant to clinicians who administer exposure therapy. The present experiments investigated the effects of conducting extinction in multiple contexts using rats as subjects in a conditioned suppression paradigm. In Experiment 1, subjects received conditioned stimulus (CS) and unconditioned stimulus (US) pairings in one context followed by extinction of that CS in one or three other contexts. When tested in an associatively neutral context (i.e., different from those of conditioning or extinction), rats that had received extinction in three contexts exhibited less responding to the CS than rats that had received extinction in one context. In Experiment 2, CS-US training occurred in either one or three contexts, followed by extinction of that CS in three other contexts. Testing in a neutral context revealed that rats conditioned in multiple contexts showed greater responding to the CS than rats trained in a single context. The results are discussed in the framework of memory retrieval, and the clinical implications are explored.

Animals↗