Showing papers in "Psychotherapy and Psychosomatics in 2015"
TL;DR: The review demonstrated that the WHO-5 has high clinimetric validity, can be used as an outcome measure balancing the wanted and unwanted effects of treatments, is a sensitive and specific screening tool for depression and its applicability across study fields is very high.
Abstract: Background: The 5-item World Health Organization Well-Being Index (WHO-5) is among the most widely used questionnaires assessing subjective psychological well-bei
2,215 citations
TL;DR: It is indicated that ACT is more effective than treatment as usual or placebo and that ACT may be as effective in treating anxiety disorders, depression, addiction, and somatic health problems as established psychological interventions.
Abstract: Background: The current study presents the results of a meta-analysis of 39 randomized controlled trials on the efficacy of acceptance and commitment therapy (ACT), including 1,821 patients with mental disorders or somatic health problems. Methods: We searched PsycINFO, MEDLINE and the Cochrane Central Register of Controlled Trials. Information provided by the ACBS (Association of Contextual Behavioral Science) community was also included. Statistical calculations were conducted using Comprehensive Meta-Analysis software. Study quality was rated using a methodology rating form. Results: ACT outperformed control conditions (Hedges' g = 0.57) at posttreatment and follow-up assessments in completer and intent-to-treat analyses for primary outcomes. ACT was superior to waitlist (Hedges' g = 0.82), to psychological placebo (Hedges' g = 0.51) and to treatment as usual (TAU) (we defined TAU as the standard treatment as usual; Hedges' g = 0.64). ACT was also superior on secondary outcomes (Hedges' g = 0.30), life satisfaction/quality measures (Hedges' g = 0.37) and process measures (Hedges' g = 0. 56) compared to control conditions. The comparison between ACT and established treatments (cognitive behavioral therapy) did not reveal any significant differences between these treatments (p = 0.140). Conclusions: Our findings indicate that ACT is more effective than treatment as usual or placebo and that ACT may be as effective in treating anxiety disorders, depression, addiction, and somatic health problems as established psychological interventions. More research that focuses on quality of life and processes of change is needed to understand the added value of ACT and its transdiagnostic nature.
682 citations
TL;DR: Clinicians need to add SSRI to the list of drugs potentially inducing withdrawal symptoms upon discontinuation, together with benzodiazepines, barbiturates, and other psychotropic drugs.
Abstract: Background: Selective serotonin reuptake inhibitors (SSRI) are widely used in medical practice. They have been associated with a broad range of symptoms, whose cl
304 citations
TL;DR: The need for a more comprehensive definition of euthymia is introduced, as a lack of a certain intensity of mood symptoms, and not as the presence of specific positive features that characterize recovery, is introduced.
Abstract: Similar considerations apply to the use of the term euthymia in unipolar depression and dysthymia, where the overlap with the concept of recovery is considerable [9, 10] . Again, euthymia is often defined essentially in negative terms, as a lack of a certain intensity of mood symptoms, and not as the presence of specific positive features that characterize recovery [9] . This introduces the need for a more comprehensive definition of euthymia.
153 citations
TL;DR: Withdrawal from SSRIs and other CNS drugs produces psychiatric symptoms that can be confounded with true relapse or recurrence of the original illness, and withdrawal symptoms must be identified to avoid prolonging treatment or giving unnecessarily high doses.
Abstract: inal symptoms at the same intensity as before treatment, entailing a return of the same episode and a new episode of illness, respectively [6, 9] . When treatment with a CNS drug is discontinued, patients can experience classic new withdrawal symptoms, rebound and/or persistent postwithdrawal disorders, or relapse/recurrence of the original illness [6, 9, 14] . New and rebound symptoms can occur for up to 6 weeks after drug withdrawal, depending on the drug elimination half-life [2, 3] , while persistent postwithdrawal or tardive disorders associated with longlasting receptor changes may persist for more than 6 weeks after drug discontinuation. Initial withdrawal symptoms from CNS drugs have been reported to be more frequent and severe when high-potency drugs and drugs with a short elimination half-life have been used [9, 10] . CNS drugs with a shorter elimination half-life and rapid onset of action also carry a higher risk of dependency and high-dose use [9, 10] . Withdrawal symptoms can be relatively short-lasting, lasting for a few hours to a few weeks with complete recovery, while others may persist and last for several months [1, 15, 16] . Fava et al. [1] have proposed using the terminology ‘withdrawal syndrome’ to replace the term ‘discontinuation syndrome’, which has been most often used to describe SSRI withdrawal. They have recommended the Selective serotonin reuptake inhibitors (SSRIs) are widely used in clinical practice, and have advanced the treatment of depression and other mental disorders. However, more studies are needed on the effects of decreasing and discontinuing these medications after their long-term use [1] . Withdrawal symptoms may occur with all SSRIs and serotonin-noradrenaline reuptake inhibitors (SNRIs) [1] , similarly to other CNS drugs, including benzodiazepines [2–4] and antipsychotics [5, 6] . Withdrawal from SSRIs and other CNS drugs produces psychiatric symptoms that can be confounded with true relapse or recurrence of the original illness [1, 2, 7] . When discontinuing or decreasing SSRIs, withdrawal symptoms must be identified to avoid prolonging treatment or giving unnecessarily high doses [6, 8] . Different types of syndromes have been described with the withdrawal from SSRIs and other CNS drug classes, including benzodiazepines, antipsychotics, antidepressants, opiates, barbiturates, and alcohol: (1) new withdrawal symptoms (classic withdrawal symptoms from CNS drugs) [1, 4–6, 9–12] , (2) rebound [2, 6, 9, 13–16] , and (3) persistent postwithdrawal disorders [7, 17, 18] ( table 1 ). These types of withdrawal need to be differentiated from relapse and recurrence of the original illness. Relapse and recurrence are the gradual return of the origReceived: October 12, 2014 Accepted after revision: January 6, 2015 Published online: February 21, 2015
123 citations
TL;DR: This study lends support to the idea that problem solving coupled with behavioural activation is an effective treatment for sD and the delivery of this intervention over the Internet might be a promising strategy for the dissemination of psychological interventions on a large scale.
Abstract: Background: Research on the effectiveness of treatments for subthreshold depression (sD) is still scarce. The aim of the study was to evaluate the efficacy of a web-based guided self-help intervention (GET.ON Mood Enhancer) in the treatment of sD. Methods: Participants with sD (n = 406) recruited from the general population via a large health insurance company were randomly allocated to a web-based cognitive behavioural intervention or to enhanced care-as-usual. The primary outcome was the reduction in depressive symptom severity as measured with the Center for Epidemiological Studies Depression Scale at post-treatment and at 6-month follow-up. Results: Participants in the intervention group showed a significantly greater pre-post reduction in depressive symptom severity (d = 1.06; 95% CI: 0.86-1.27) compared to the control condition (d = 0.29; 95% CI: 0.10-0.49). The corresponding between-group effect size was d = 0.69 (95% CI: 0.49-0.89). At 6-month follow-up the effect was reduced to d = 0.28 (95% CI: 0.09-0.48) but was still statistically significant (F1, 403 = 9.240, p = 0.003). Conclusions: This study lends support to the idea that problem solving coupled with behavioural activation is an effective treatment for sD. In addition, the delivery of this intervention over the Internet might be a promising strategy for the dissemination of psychological interventions for sD on a large scale.
84 citations
TL;DR: Depression was found to be the most common affective prodrome of medical disorders and was consistently reported in Cushing's syndrome, hypothyroidism, hyperparathyroidism), pancreatic and lung cancer, myocardial infarction, Wilson's disease, and AIDS.
Abstract: Background: Affective disturbances involving alterations of mood, anxiety and irritability may be early symptoms of medical illnesses. The aim of this paper was t
76 citations
TL;DR: As a non-expensive and potentially cost-saving, generic intervention, DIALOG+ may be widely used and may improve the effectiveness of community treatment and further trials should test DIALog+ in different patient groups and contexts.
Abstract: Background: DIALOG+ was developed as a computer-mediated intervention, consisting of a structured assessment of patients' concerns combined with a solution-focuse
74 citations
TL;DR: Common neurofeedback methods are outlined, the tenuous state of the evidence is illuminated, and future directions to further unravel the potential merits of this contentious therapeutic prospect are sketched out.
Abstract: Neurofeedback draws on multiple techniques that propel both healthy and patient populations to self-regulate neural activity. Since the 1970s, numerous accounts have promoted electroencephalography-neurofeedback as a viable treatment for a host of mental disorders. Today, while the number of health care providers referring patients to neurofeedback practitioners increases steadily, substantial methodological and conceptual caveats continue to pervade empirical reports. And yet, nascent imaging technologies (e.g., real-time functional magnetic resonance imaging) and increasingly rigorous protocols are paving the road towards more effective applications and a better scientific understanding of the underlying mechanisms. Here, we outline common neurofeedback methods, illuminate the tenuous state of the evidence, and sketch out future directions to further unravel the potential merits of this contentious therapeutic prospect.
73 citations
TL;DR: Evidence has emerged that PDT is efficacious or possibly efficacious in a wide range of common mental disorders and further research is required for those disorders for which sufficient evidence does not yet exist.
Abstract: Background: The Task Force on Promotion and Dissemination of Psychological Procedures proposed rigorous criteria to define empirically supported psychotherapies. According to these criteria, 2 randomized controlled trials (RCTs) showing efficacy are required for a treatment to be designated as ‘efficacious' and 1 RCT for a designation as ‘possibly efficacious'. Applying these criteria modified by Chambless and Hollon, this article presents an update on the evidence for psychodynamic therapy (PDT) in specific mental disorders. Methods: A systematic search was performed using the criteria by Chambless and Hollon for study selection, as follows: (1) RCT of PDT in adults, (2) use of reliable and valid measures for diagnosis and outcome, (3) use of treatment manuals or manual-like guidelines, (4) adult population treated for specific problems and (5) PDT superior to no treatment, placebo or alternative treatment or equivalent to an established treatment. Results: A total of 39 RCTs were included. Following Chambless and Hollon, PDT can presently be designated as efficacious in major depressive disorder (MDD), social anxiety disorder, borderline and heterogeneous personality disorders, somatoform pain disorder, and anorexia nervosa. For MDD, this also applies to the combination with pharmacotherapy. PDT can be considered as possibly efficacious in dysthymia, complicated grief, panic disorder, generalized anxiety disorder, and substance abuse/dependence. Evidence is lacking for obsessive-compulsive, posttraumatic stress, bipolar and schizophrenia spectrum disorder(s). Conclusions: Evidence has emerged that PDT is efficacious or possibly efficacious in a wide range of common mental disorders. Further research is required for those disorders for which sufficient evidence does not yet exist.
72 citations
TL;DR: The extent to which moral injury suffered by traumatized refugees contributed to psychological outcomes, including posttraumatic stress disorder (PTSD), depression, explosive anger and mental healthrelated quality of life is investigated.
Abstract: et al. [8]. Example items of the Moral Injury Scale include ‘I am troubled by morally wrong things done by other people’ and ‘I feel betrayed by people I once trusted’. All scales were translated into study languages and backtranslated, with discrepancies being rectified by the translators and research team. Hierarchical regression analyses ( table 1 ) were used to predict psychological outcomes including PTSD and depression symptoms, explosive anger reactions and mental health-related quality of life. Demographics were entered at step 1, trauma exposure was entered at step 2, living difficulties were entered at step 3, and moral injury was entered at step 4. Moral injury significantly predicted all psychological outcomes, after controlling for demographics, the impact of trauma and living difficulties. Moral injury accounted for 16% of the variance in PTSD, 16% in depression, 10% in explosive anger and 10% in mental health-related quality of life. Findings from this study indicate that the extent to which the individual is troubled by acts that have transgressed his or her morals contributes significantly to mental health outcomes and quality of life, even after controlling for dosage of trauma exposure and postmigration stressors. These results are consistent with theoretical models and empirical evidence from research with trauma survivors that suggest that cognitive appraisals are key contributing factors to posttrauma mental health [9] . The potential for traumatic events to challenge core cognitive belief systems may be especially strong in the context of human-instigated trauma, persecution or torture. In the current study, the perception of traumatic events as transgressions against basic moral frameworks was strongly associated with poor mental health outcomes. This is consistent with evidence that survivors of the war in former Yugoslavia believed less in the benevolence of other people [10] . Taken together, these findings indicate that exposure to war trauma and persecution poses fundamental challenges to core cognitive frameworks, which may negatively impact on subsequent mental health and functioning. To date, treatments for PTSD have combined extinction learning and cognitive interventions to address core symptoms of the disorder. The focus on fear extinction reflects the implication of fear-conditioning principles in models of posttraumatic stress reactions. PTSD symptoms are targeted in therapy via extinction learning, in which the trauma survivor learns that conditioned cues are not dangerous, and anxiety is reduced accordingly. While there is strong evidence that this approach is effective in reducing posttraumatic stress responses, it may not be sufficient for moral injury-related distress; for example, exposure therapy is less effective in posttraumatic anger responses than fear reactions [11] . In contrast, cognitive aspects of PTSD interventions have centred on correcting maladaptive appraisals related to the traumatic event to reduce distress and improve functioning [8] . Findings from this study point to the potential for taking a cognitive approach that Refugees are typically exposed to multiple types of traumatic events, which have a deleterious impact on their mental health [1] . While research has focused on posttraumatic stress responses, theorists and clinicians have long recognized that the effects of refugee trauma extend beyond fear-related reactions. The concept of ‘moral injury’ has emerged from work in military settings and can be conceptualized as ‘the lasting psychological, biological, spiritual, behavioral and social impact of ... bearing witness to acts that transgress deeply held moral beliefs and expectations’ [2] . In the context of persecution-related violence, individuals are often exposed to events that directly contravene deeply held moral frameworks, such as murder, sexual assault and torture. To date, however, no research has examined moral injury in civilians exposed to persecution and trauma. In this study, we investigated the extent to which moral injury suffered by traumatized refugees contributed to psychological outcomes, including posttraumatic stress disorder (PTSD), depression, explosive anger and mental healthrelated quality of life. Participants in this study were 134 treatment-seeking refugees and asylum seekers residing in Switzerland. The sample comprised 78.4% males, and the participants had a mean age of 42.4 years (SD = 9.8). The participants were from a variety of countries, including 53% from Turkey, 12% from Iran, 8% from Sri Lanka, 5% from Bosnia, 5% from Iraq, 5% from Afghanistan and 13% from other countries. Most participants (85.1%) had been exposed to torture. 51.5% of the participants met DSM-5 criteria for PTSD, 80.6% met criteria for depression, and 65.7% reported experiencing episodes of anger sometimes or often. Participants completed self-report measures using a psychologist-assisted computer-based assessment tool, and were reimbursed CHF 40 (approx. USD 40) for participation. These scales indexed trauma exposure [3] , postmigration stressor s [4] , PTSD symptoms [5] , depression symptoms [6] and mental health-related quality of life [7] . The scale indexing explosive anger was developed for the current study, and the Moral Injury Scale was adapted from the Moral Injury Events Scale, developed by Nash
TL;DR: The CBASP program appears as a feasible acute treatment for treatment-resistant CD inpatients with promising outcome, however, the continuation of treatment after discharge should be optimized especially for patients with subjective deterioration during treatment.
Abstract: Background: The Cognitive Behavioral Analysis System of Psychotherapy (CBASP), initially developed as an outpatient treatment for chronic depression (CD), has bee
TL;DR: Proof-of-principle data suggest that ACT is a viable treatment option for treatment-resistant PD/A patients, with medium-to-large effect sizes that were maintained for at least 6 months.
Abstract: Background: Nonresponsiveness to therapy is generally acknowledged, but only a few studies have tested switching to psychotherapy. This study is one of the first to examine the malleability of treatment-resistant patients using acceptance and commitment therapy (ACT). Methods: This was a randomized controlled trial that included 43 patients diagnosed with primary panic disorder and/or agoraphobia (PD/A) with prior unsuccessful state-of-the-art treatment (mean number of previous sessions = 42.2). Patients were treated with an ACT manual administered by novice therapists and followed up for 6 months. They were randomized to immediate treatment (n = 33) or a 4-week waiting list (n = 10) with delayed treatment (n = 8). Treatment consisted of eight sessions, implemented twice weekly over 4 weeks. Primary outcomes were measured with the Panic and Agoraphobia Scale (PAS), the Clinical Global Impression (CGI), and the Mobility Inventory (MI). Results: At post-treatment, patients who received ACT reported significantly more improvements on the PAS and CGI (d = 0.72 and 0.89, respectively) than those who were on the waiting list, while improvement on the MI (d = 0.50) was nearly significant. Secondary outcomes were consistent with ACT theory. Follow-up assessments indicated a stable and continued improvement after treatment. The dropout rate was low (9%). Conclusions: Despite a clinically challenging sample and brief treatment administered by novice therapists, patients who received ACT reported significantly greater changes in functioning and symptomatology than those on the waiting list, with medium-to-large effect sizes that were maintained for at least 6 months. These proof-of-principle data suggest that ACT is a viable treatment option for treatment-resistant PD/A patients. Further work on switching to psychotherapy for nonresponders is clearly needed. © 2015 S. Karger AG, Basel.
TL;DR: Support is lent to psychosocial intervention as a tool in the management of COPD due to indications of possible publication bias towards positive findings, however, the results should be interpreted with some caution, and more high quality research is needed.
Abstract: Background: Psychosocial intervention has been suggested as a potentially effective supplement to medical treatment in chronic obstructive pulmonary disease (COPD), but no reviews so far have quantified the existing research in terms of both psychological and physical health outcomes. We therefore conducted a systematic review and meta-analysis of controlled trials evaluating the effects of psychosocial interventions on psychological and physical health outcomes in COPD. Methods: Two independent raters screened 1,491 references for eligibility. Twenty independent studies investigating a total of 1,361 patients were included, assessed for their methodological quality, and subjected to meta-analytic evaluation. Results: After adjusting for potential publication bias, a statistically significant overall effect was found for psychological (Hedges' g = 0.38, 95% confidence interval, CI = 0.19-0.58; p Conclusions: Taken together, the results lend support to psychosocial intervention as a tool in the management of COPD. However, due to indications of possible publication bias towards positive findings, the results should be interpreted with some caution, and more high quality research is needed.
TL;DR: Based on the current evidence, pharmacological treatment of anorexia nervosa with SGAs cannot be generally recommended although some individuals or subgroups of patients might benefit from an antipsychotic medication.
Abstract: Background: Second-generation antipsychotic drugs (SGAs) are increasingly administered to achieve weight gain in anorexia nervosa. In this meta-analysis, we aimed to determine if any evidence for this treatment option can be derived from randomized controlled trials (RCTs). Methods: Based on the ‘World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Pharmacological Treatment of Eating Disorders', a systematic update literature search was applied to identify all RCTs investigating the efficacy, acceptability, and tolerability of SGAs in anorexia nervosa in comparison to placebo/no treatment. The primary outcome was weight gain measured by mean change in body mass index (BMI). Secondary outcomes were mean changes in Yale-Brown-Cornell Eating Disorders Scale (YBC-EDS) total score and Eating Disorders Inventory (EDI) total score and premature discontinuation of treatment. Employing a random-effects model standardized mean differences based on Hedges's g and Mantel-Haenszel risk ratios were calculated. Results: Seven RCTs (n = 201) investigating olanzapine (N = 4), quetiapine (N = 2), and risperidone (N = 1) were included. We found no statistically significant between-group differences for mean BMI change when pooling the SGAs (N = 7, n = 161; Hedges's g = 0.13, 95% CI: -0.17 to 0.43; p = 0.4) and when examining the individual drugs. Furthermore, the SGAs failed to differentiate statistically significantly from placebo/no treatment for all secondary outcomes. Conclusions: Based on the current evidence, pharmacological treatment of anorexia nervosa with SGAs cannot be generally recommended although some individuals or subgroups of patients might benefit from an antipsychotic medication. Further research is required to identify which patients will likely benefit from such a treatment option.
TL;DR: Screening and assessment of psychological variables, especially coping, could help in identifying cancer patients at risk for chemotherapy-induced nausea, in spite of the use of antiemetic treatment.
Abstract: Background: Chemotherapy-induced nausea and vomiting (CINV) continue to be a distressing problem still reported by cancer patients, with negative consequences on quality of life (QoL). Aims: To prospectively explore the association of psychosocial variables, including emotional distress, maladaptive coping styles and the doctor-patient relationship, with CINV and QoL among cancer outpatients. Methods: A prospective study was conducted on 302 consecutive cancer patients (response rate 80.9%) in Austria, Italy and Spain. The Distress Thermometer (DT), the Mini-Mental Adjustment to Cancer (Mini-MAC), and the Patient Satisfaction with Doctor Questionnaire (PSQ) were used to assess psychosocial variables before chemotherapy. In the 5 days after chemotherapy, CINV was examined by using a daily diary, and the Functional Living Index for Emesis (FLIE) was used to assess QoL. Results: More than half of the patients reported nausea (54%), and a small percentage reported vomiting (14%). CINV had a negative impact on QoL (FLIE caseness, p Conclusions: Screening and assessment of psychological variables, especially coping, could help in identifying cancer patients at risk for chemotherapy-induced nausea, in spite of the use of antiemetic treatment.
TL;DR: Telephone-based CBT produced a significantly greater reduction in depressive symptoms than standard care during the postpartum period, and was associated with significantly lower depressive symptoms compared with standard care.
Abstract: Background: Cognitive-behavioral therapy (CBT) is one of the most effective interventions for postnatal depression However, few studies have evaluated the effect of CBT delivered via telephone for newborn mothers The purpose of this study was to evaluate the efficacy of telephone-based CBT for postnatal depression at 6 weeks and 6 months postpartum Methods: A multisite randomized controlled trial was conducted in the postnatal units at 3 regional hospitals in Hong Kong A total of 397 women with an Edinburgh Postnatal Depression Scale (EPDS) score ≥10 on the second or third day postpartum were randomized to receive telephone-based CBT (n = 197) or standard care (n = 200) Primary outcome was the total EPDS score A cutoff score of 9/10 on the EPDS was used to define women at risk of postnatal depression Results: Telephone-based CBT was associated with significantly lower depressive symptoms compared with standard care, when assessed at 6 weeks postpartum in the subgroups of mothers with minor depression (EPDS 10-12; difference = 190, 95% CI: 072-308; p = 0002) and major depression (EPDS ≥13; difference = 500, 95% CI: 312-688; p Conclusions: Telephone-based CBT produced a significantly greater reduction in depressive symptoms than standard care during the postpartum period
TL;DR: EBM does not do justice to the importance of patient-doctor interactions and provides an oversimplified and reductionistic view of treatment, and a method of clinical inquiry within RCT that can enhance the applicability of results to clinical decision making is developed.
Abstract: Each therapeutic act may be seen as a result of multiple ingredients that may be specific or nonspecific [6] . Expectations, preferences, motivation, and patient-doctor interactions are examples of variables that may affect treatment outcome [6, 7] . The changed spectrum of medical disorders (shifted toward aging and chronicity) and the interindividual differences in health priorities make the focus on single diseases potentially misleading, whereas there is growing awareness that the aim of the treatment should refer to personal goals (from attainment of cure to prevention of recurrence, from removal of functional impairment to alleviation of symptoms) [8] . EBM does not do justice to the importance of these interactions and provides an oversimplified and reductionistic view of treatment. Finally, the presence of investigators with substantial financial conflicts of interest in panels concerned with clinical guidelines and the excessive reliance of metaanalyses on industry-funded studies constitute two major sources of bias in literature interpretation [1, 9] . Horwitz et al. [10] developed a method of clinical inquiry within RCT that can enhance the applicability of results to clinical decision making. Reanalyzing the BetaBlocker Heart Attack Trial, they found that propranolol reduced the risk of dying for the ‘average’ patient who survived an acute myocardial infarction, whereas it was harmful in a subgroup characterized by specific cotherapy histories. If we accept the possibility that a treatment The gap between clinical guidelines developed by evidence-based medicine (EBM) and the real world of clinicians and patients has been widely recognized. There is currently little evidence that EBM has actually improved patient care [1] . It is thus not surprising that most of the time clinicians rely more on their own experience and that of their colleagues (tacit knowledge or ‘mindlines’) than on explicit evidence from research [2] . Feinstein and Horwitz [3] were among the first to warn about excessive reliance on randomized controlled trials (RCT) and meta-analyses that were not intended to answer questions about the treatment of individual patients. The results of these types of trials may show comparative efficacy of treatments for the average randomized patient but not for those whose characteristics, such as severity of symptoms, comorbidity and other clinical features, depart from standard presentations [3] . In addition, meta-analyses often include highly heterogeneous studies and ascribe conflicting results to random variability, whereas different outcomes may reflect different patient populations, enrollment and protocol characteristics [4] . Even though personalized medicine, described as genomicsbased knowledge, has promised to approach each patient as the biological individual he/she is, the practical applications still have a long way to go and neglect of social and behavioral features may actually lead to ‘depersonalized’ medicine [5] . Other limitations have emerged over time. Received: July 11, 2014 Accepted after revision: July 21, 2014 Published online: December 24, 2014
TL;DR: The DCPR system showed its clinical utility regarding the following clinical issues: subtyping medical patients, identifying subthreshold or undetected syndromes, evaluating the burden of somatic syndrome, and predicting treatment outcomes and identifying risk factors.
Abstract: Background: The Diagnostic Criteria for Psychosomatic Research (DCPR) are a set of 12 psychosomatic syndromes and are provided with a reliable diagnostic structured interview. The DCPR have been proposed 20 years ago as an integrative assessment strategy that supplements the traditional psychiatric nosography for identifying patients within a given illness population whose psychosocial factors have clinical significance. This paper reviews their clinical utility, conceived as the degree and the amount of influence that the instrument has on multiple decisions and outcomes in clinical practice. Methods: Published reports which involved the use of the DCPR were identified by searching electronic databases. Studies which best displayed the clinical utility of the DCPR system were then selected and reviewed. Results: The DCPR system showed its clinical utility regarding the following clinical issues: (1) subtyping medical patients, (2) identifying subthreshold or undetected syndromes, (3) evaluating the burden of somatic syndromes, and (4) predicting treatment outcomes and identifying risk factors. Conclusions: The DCPR may help clinicians during the assessment process to recognize clinical conditions underlying symptom presentation, with important therapeutic and prognostic implications.
TL;DR: All hypnotics had higher risks for high-dose use compared to diazepam in continuous users and the triazolobenzodiazepines alprazolam and Triazolam were most problematic.
Abstract: Background: Benzodiazepines are not all the same concerning their risk of high-dose use. Methods: We studied benzodiazepine use from the Luxembourg national records of all insured. We calculated the 12-year prevalence from 1995 to 2007. Benzodiazepine users were divided into 3 groups, short-term with no longer than 3-month intake, intermediate with multiple administration with at least a 1-year interruption, and continuous who never stopped. A high-dose user (HDU) was defined as a patient who received a higher dose than the yearly maximum usual therapeutic dose. Results: An average of 16.0% of the adult insured population received at least 1 benzodiazepine annually, 42.9% were older than 50, 55.9% were women, and 5.4% were HDUs. We found that 32.6% were short-term users, 49.0% intermediate and 18.4% continuous. Compared to diazepam, hypnotics had higher risks for high-dose use in at least 1 age group at first-benzodiazepine intake, the risks being greater in elderly subjects and women, the highest risks being with triazolam (adjusted odds ratio = 215.85; 95% confidence interval = 133.75-348.35) in the 69- to 105-year-old group at first-benzodiazepine intake. Anxiolytics had a low risk except for alprazolam and prazepam in the 69- to 105-year-old group at first-benzodiazepine intake, clonazepam and clobazam had the lowest risk in 18- to 43-year-olds at first-benzodiazepine intake. Alprazolam had dispensed volumes increased by threefold over the 12-year period. Conclusion: All hypnotics had higher risks for high-dose use compared to diazepam in continuous users. Two anxiolytics, clonazepam and clobazam, had the lowest risks. Hypnotics and the triazolobenzodiazepines alprazolam and triazolam were most problematic. Elderly subjects and women are at greater risks.
TL;DR: Group size does not seem to affect the general efficacy of the intervention which is of importance for settings in which large treatment groups are not feasible due to limited referral.
Abstract: Background: Meta-analyses have been inconclusive about the efficacy of cognitive behaviour therapies (CBTs) delivered in groups of patients with chronic fatigue syndrome (CFS) due to a lack of adequate studies. Methods: We conducted a pragmatic randomised controlled trial with 204 adult CFS patients from our routine clinical practice who were willing to receive group therapy. Patients were equally allocated to therapy groups of 8 patients and 2 therapists, 4 patients and 1 therapist or a waiting list control condition. Primary analysis was based on the intention-to-treat principle and compared the intervention group (n = 136) with the waiting list condition (n = 68). The study was open label. Results: Thirty-four (17%) patients were lost to follow-up during the course of the trial. Missing data were imputed using mean proportions of improvement based on the outcome scores of similar patients with a second assessment. Large and significant improvement in favour of the intervention group was found on fatigue severity (effect size = 1.1) and overall impairment (effect size = 0.9) at the second assessment. Physical functioning and psychological distress improved moderately (effect size = 0.5). Treatment effects remained significant in sensitivity and per-protocol analyses. Subgroup analysis revealed that the effects of the intervention also remained significant when both group sizes (i.e. 4 and 8 patients) were compared separately with the waiting list condition. Conclusions: CBT can be effectively delivered in groups of CFS patients. Group size does not seem to affect the general efficacy of the intervention which is of importance for settings in which large treatment groups are not feasible due to limited referral.
TL;DR: This study highlights the need to understand more fully the rationale for the continued use of antipsychotic medication in patients with a history of psychiatric illness.
Abstract: a Mental Health Research Center, Eastern State Hospital, Lexington, Ky. , and b Department of Psychiatry, New York State Psychiatric Institute and Columbia University, New York, N.Y. , USA; c Psychiatry and Neurosciences Research Group (CTS-549), Institute of Neurosciences, University of Granada, Granada , d Biomedical Research Centre in Mental Health Net (CIBERSAM), Santiago Apóstol Hospital, University of the Basque Country, Vitoria-Gasteiz ,
TL;DR: BIT is a promising means of lowering LOS on general medical units while providing a high level of care and staff support and a statistically significant spillover effect was suggested by the overall improvement of Los on units implementing BIT.
Abstract: Background: Mental illness correlates with an increased length of stay (LOS) for patients hospitalized for medical conditions. While psychiatric consultations help manage mental illness among those hospitalized for medical conditions, consultations initiated by nonpsychiatric mental disease may lack maximum effectiveness. Methods: In a before-and-after design, in 2 contiguous years LOS for internist-initiated, conventional consultation (CC) as usual treatment was compared to LOS of a proactive, mental health professional-initiated, multidisciplinary intervention delivered by the behavioral intervention team (BIT) on the same units. The patient populations included general medical patients with a variety of illnesses. Patients were treated in 3 different inpatient settings with a total capacity of 92 beds serving 15,858 patient visits over 3 comparison years. BIT comprised a psychiatrist, a nurse, and a social worker, each of whom performed the specific tasks of their professional discipline, while collaborating among themselves and their health-care colleagues. BIT provided timely, appropriate, and effective patient care alongside consultative advice and education to their corresponding professional peers. BIT was compared to CC on the outcome of LOS. Results: There was a statistically significant reduction of LOS favoring BIT over CC for patients with an LOS of Conclusion: BIT is a promising means of lowering LOS on general medical units while providing a high level of care and staff support.
TL;DR: CBASP and ESC/CM appear to be equally effective treatment options for chronically depressed outpatients and for nonimprovers to the initial treatment, it is efficacious to augment with medication in the case of nonresponse to CBASp and vice versa.
Abstract: Background: A specific psychotherapy for chronic depression, the Cognitive Behavioral Analysis System of Psychotherapy (CBASP), was compared to escitalopram (ESC)
TL;DR: It is suggested that the abnormal brain activity in several of these regions, previously demonstrated in FD, may be due to a sustained endocannabinoid system dysfunction, identifying it as a potential novel target for treatment and warranting further studies to elucidate whether it is also a feature of other FGIDs or FSSs.
Abstract: Background: Functional dyspepsia (FD) is a prevalent functional gastrointestinal disorder (FGID) defined by chronic epigastric symptoms in the absence of organic
TL;DR: An effect of alliance on outcome in psychopharmacology is suggested, which is not merely the result of previous symptomatic levels, and may be more robust in conditions that do not include active treatment (placebo), possibly serving as a compensatory effect.
Abstract: Background: Previous studies have shown that in psychotherapy alliance is a predictor of symptomatic change, even while accounting for the temporal precedence between alliance and symptoms. However, the extent to which alliance predicts outcomes in psychopharmacology is yet to be fully investigated considering the fact that alliance can be the result, rather than the cause, of symptomatic change. The current prospective study examined whether the alliance predicts outcomes in psychopharmacology, while controlling for previous symptomatic change throughout the course of treatment. Methods: Data from a psychopharmacological randomized controlled trial for the treatment of adult major depression (n = 42), including the patients' rating of the alliance with the physicians, were analyzed. Multilevel models controlling for autoregressive lag of the dependent variable were used in all analyses to examine the effect of alliance on outcome. Results: The effect of alliance on outcome, while controlling for prior symptomatic levels, was significant and restricted to the middle phase of treatment (week 4, p = 0.005), when most of the reductions in symptoms were observed. Exploratory analyses of the differences between placebo and medication conditions suggest that the differences between the patients in their average alliance levels predicted a greater reduction in symptoms in the placebo compared to the medication conditions (p = 0.008). The main limitation is the small cohort size. Conclusions: The findings suggest an effect of alliance on outcome in psychopharmacology, which is not merely the result of previous symptomatic levels. This effect may be more robust in conditions that do not include active treatment (placebo), possibly serving as a compensatory effect.
TL;DR: These results are a first indication that mobile CT in addition to TAU is effective in treating recurrently depressed patients in remission, however, demonstration of its long-term effectiveness and replication remains necessary.
Abstract: Background: Internet-based cognitive therapy with monitoring via text messages (mobile CT), in addition to treatment as usual (TAU), might offer a cost-effective way to treat recurrent depression. Method: Remitted patients with at least 2 previous episodes of depression were randomized to mobile CT in addition to TAU (n = 126) or TAU only (n = 113). A linear mixed model was used to examine the effect of the treatment condition on a 3-month course of depressive symptoms after remission. Both an intention-to-treat analysis (n = 239) and a completer analysis (n = 193) were used. Depressive symptoms were assessed using the Inventory of Depressive Symptomatology (IDS-SR30) at baseline and 1.5 and 3 months after randomization. Results: Residual depressive symptoms showed a small but statistically significant decrease in the intention-to-treat group over 3 months in the mobile CT group relative to the TAU group (difference: -1.60 points on the IDS-SR30 per month, 95% CI = -2.64 to -0.56, p = 0.003). The effect of the treatment condition on the depressive symptomatology at the 3-month follow-up was small to moderate (Cohen's d = 0.44). All analyses among completers (≥5 modules) showed more pronounced treatment effects. Adjustment for unequally distributed variables did not markedly affect the results. Conclusions: Residual depressive symptoms after remission showed a more favorable course over 3 months in the mobile CT group compared to the TAU group. These results are a first indication that mobile CT in addition to TAU is effective in treating recurrently depressed patients in remission. However, demonstration of its long-term effectiveness and replication remains necessary. © 2015 S. Karger AG, Basel.
TL;DR: Group psychotherapeutic treatments can improve negative symptoms and social functioning deficits in the treatment of schizophrenia and appears to be non-specific.
Abstract: Background: Different psychotherapeutic treatments for schizophrenia are delivered in groups. However, little is known about the effectiveness of these group therapies for people with schizophrenia across different treatments with varying therapeutic orientations. This review aimed to (1) estimate the effect of different group psychotherapeutic treatments for schizophrenia and (2) explore whether any overall ‘group effect' is moderated by treatment intensity, diagnostic homogeneity and therapeutic orientation. Methods: A systematic search of randomised controlled trials exploring the effectiveness of group psychotherapeutic treatments for people with schizophrenia was conducted. Random-effect meta-analyses on endpoint symptom scores compared group psychotherapeutic treatments with treatment as usual and active sham groups. Findings on social functioning were described narratively, and meta-regression analyses on group characteristics were carried out. Results: Thirty-four eligible trials were included. A weak-to-moderate significant between-group difference in favour of group psychotherapeutic treatments was found for negative symptom scores (standard mean difference = -0.37, 95% confidence interval -0.60, -0.14; p 2 = 59.8%) only when compared to treatment as usual and not to active sham groups. Improved social functioning was reported as a treatment outcome in the majority of studies compared to treatment as usual. The ‘group effect' on negative symptoms was positively related to ‘treatment intensity' (β = 0.32, standard error = 0.121; p Conclusion: Group psychotherapeutic treatments can improve negative symptoms and social functioning deficits in the treatment of schizophrenia. The effect occurs across different treatments and appears to be non-specific. Future research should identify the underlying mechanisms for the positive effect of participating in groups and explore how they can be maximised to increase the therapeutic benefit.
TL;DR: In this article, the authors proposed Cognitive Behavioural Therapy (CBT) as an important treatment approach for Major Depressive Disorder (MDD) which causes a massive disease burden worldwide.
Abstract: Background: Major depressive disorder (MDD) causes a massive disease burden worldwide. Cognitive behavioural therapy (CBT) is an important treatment approach for
TL;DR: The present pilot study confirms that ANR (‘to stop bad feelings, psychological pain’) is reported most frequently as the reason for SB and supports the concept that people may attempt suicide to relieve a painful or unbearable internal state and places psychological pain at the core of SB.
Abstract: this study have been reported elsewhere [5] . Basically, 82 individuals who had attempted suicide at least once during their lifetime were recruited from a psychiatric short-stay unit in 2012. All participants were administered the Spanish version of the Self-Injurious Thoughts and Behaviors Interview (SITBI) [5] . The characteristics of suicide attempts included the reported functions using a Likert scale (from 0 to 4) and referred to the most lethal suicide attempt recalled by the participant, as stated in the SITBI. Significant variables (p < 0.05) in univariate analyses were introduced in multivariate logistic regression models ( table 1 ). Most of the 82 individuals were Caucasian, single and had high school education. 49% were women. The mean age was 43.3 years (SD = 10.3). Among these 82 individuals there were 11 (13%) major repeaters ( ≥ 5 attempts) [2] and 71 (87%) nonmajor repeaters, respectively, including 35 (42%) with a single attempt and 36 (45%) with 2–4 lifetime suicide attempts. The univariate analyses of clinical variables indicated that there were no significant differences in clinical variables between repeaters and nonmajor repeaters, with the exception of borderline personality disorder (BPD; 45 vs. 14%; Fisher’s exact test, p = 0.027; OR = 5.0; 95% CI = 1.3–19.5). All major repeaters and 93% of the remaining suicide attempters had at least one axis I diagnosis. Major repeaters were statistically more likely to report APR than nonmajor repeaters (OR = 4.9; 95% CI = 1.3–18.3). ANR and social negative and social positive reinforcement were not significantly more frequent in major repeaters ( table 1 ). A logistic regression model with ‘major attempter’ as the dependent variable verified that the association between major repeater status and APR was not completely explained by the association between major attempter status and BPD ( table 1 , footnotes b and c). The present pilot study confirms that ANR (‘to stop bad feelings, psychological pain’) is reported most frequently as the reason for SB. In our sample, these reports were present in almost all attempters (86% of nonmajor repeaters and 91% of major repeaters). This finding supports the concept that people may attempt suicide to relieve a painful or unbearable internal state [6] and places psychological pain at the core of SB [7] . Shneidman [7] and, more recently, Tossani [8] stressed the strong link between psychological pain and SB. However, ANR did not differentiate between major and nonmajor repeaters in our pilot study. On the other hand, major repeaters were nearly 5 times more likely than nonmajor repeaters to endorse APR (‘to feel something, Empty societies create empty people. No societies perhaps have ever been more empty than those that exist in our present time, on the frontiers of modernity.1