Additional Psychological Treatment Research Articles

The Clinical Symptoms and Psychological Status of Biofeedback Electrical Stimulation Combined with Pelvic Floor Muscle Training during the Treatment of Mild Stress Urinary Incontinence after Holmium Laser Enucleation of the Prostate

Introduction: To study the clinical symptoms and psychological status of biofeedback electrical stimulation combined with pelvic floor muscle training during the treatment of mild stress urinary incontinence (SUI) after holmium laser enucleation of the prostate (HoLEP). Methods: Group A was treated by biofeedback and electrical stimulation; Group B was treated by pelvic floor muscle training; and Group C was treated by biofeedback and electrical stimulation combined with pelvic floor muscle training. Patients in the 3 groups had follow-up evaluations every 8, 16, and 24 weeks. Clinical symptoms of urinary incontinence were assessed using the 24-h urinary pad test, the Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI-SF); and psychological status was evaluated using the modified Hospital Anxiety Depression Scale (HADS). Results: The results of ICIQ-UI-SF showed that there were differences within and between the three groups at 8 weeks, 16 weeks, and 24 weeks (p < 0.05). The results of the 24-h pad tests were similar (p < 0.05), except for no difference between group B and group C at 8 weeks (p > 0.05). In the study with the score of HADS >35, the differences among the three groups were statistically significant (p < 0.05). There was no significant difference among the three groups at 0 and 8 weeks (p > 0.05). There were differences in the results between group C and the other two groups at 16 and 24 weeks of treatment (p < 0.05). For patients with HADS <35 at week 0, the results were basically the same except for the difference between groups at week 8. HADS of all patients were no statistical difference (p > 0.05). Conclusions: Biofeedback electrical stimulation combined with pelvic floor muscle training is an efficient nonsurgical combination therapy for the symptoms of SUI after HoLEP for benign prostatic hyperplasia. In addition, the recovery of the patient’s psychological state does not coincide with the recovery of urinary incontinence; therefore, we propose that patients still need additional psychological treatment after SUI disappears.

An investigation of treatment return after psychological therapy for depression and anxiety.

Some patients return for further psychological treatment in routine services, although it is unclear how common this is, as scarce research is available on this topic. To estimate the treatment return rate and describe the clinical characteristics of patients who return for anxiety and depression treatment. A large dataset (N=21,029) of routinely collected clinical data (2010-2015) from an English psychological therapy service was analysed using descriptive statistics. The return rate for at least one additional treatment episode within 1-5 years was 13.7%. Furthermore, 14.5% of the total sessions provided by the service were delivered to treatment-returning patients. Of those who returned, 58.0% continued to show clinically significant depression and/or anxiety symptoms at the end of their first treatment, while 32.0% had experienced a demonstrable relapse before their second treatment. This study estimates that approximately one in seven patients return to the same service for additional psychological treatment within 1-5 years. Multiple factors may influence the need for additional treatment, and this may have a major impact on service activity. Future research needs to further explore and better determine the characteristics of treatment returners, prioritise enhancement of first treatment recovery, and evaluate relapse prevention interventions.

A Psychological Intervention Program for Patients with Cerebral Infarction

Introduction: Cerebral infarction is one of the most common cerebrovascular diseases. The sequelae caused by cerebral infarction, including limb paralysis, crooked mouth corners, language barriers, etc., seriously affect the patient’s physical and mental health and enthusiasm for rehabilitation training. Therefore, psychological intervention has important positive significance for the rehabilitation and nursing of patients with cerebral infarction. Methods: This is a single-blind controlled study. 168 patients with cerebral infarction who met the inclusion criteria and visited our hospital from January 2018 to January 2020 were randomly divided into a control group (n = 84) and an intervention group (n = 84). The patients in the intervention group received an additional 3-month psychological treatment on the basis of the patients in the control group. The National Institutes of Health Stroke Scale (NIHSS), Activities of Daily Living (ADL) scale, Mini-Mental State Examination (MMSE), and Hamilton Depression Rating Scale (HAMD) were measured before and after the psychological intervention. Results: The 3-month psychological intervention we designed significantly reduced the NIHSS and HAMD scores of patients with cerebral infarction compared with traditional rehabilitation care for cerebral infarction, implying that our psychological intervention courses can improve patients’ cognitive function and suppress patients’ depression. Consistently, our psychological intervention also significantly improved ADL and MMSE scores 3 months after the onset of cerebral infarction patients, implying that this psychological intervention helped patients recover their daily functions relative to conventional care. Conclusion: Psychological intervention can be used as an adjunct therapy in the treatment and nursing of patients with cerebral infarction.

EFFECTIVENESS OF BEHAVIOURAL MEDICAL REHABILITATION UNDER REALLIFE CONDITIONS IN GERMANY: A PROPENSITY-SCORE MATCHED ANALYSIS

ObjectivesIn Germany, behavioural medical rehabilitation programmes have been implemented for patients with musculoskeletal disorders and additional mental health comorbidity. The aim of this cohort study is to assess the relative effectiveness of behavioural medical rehabilitation under real-life conditions.DesignParticipants received either a common or behavioural medical rehabilitation programme. Propensity score matching was used to provide balanced samples of both groups (German Clinical Trials Register: DRKS00016404).ParticipantsA total of 360 patients treated in behavioural medical rehabilitation were compared with 360 matched controls. The mean age of study participants was approximately 53.5 years (standard deviation (SD)=7.0 years) and 74.0% were women.ResultsNo significant and clinical meaningful differences were found in return to work, applications for disability pension, and the number of patients receiving social security benefits in the year after rehabilitation. However, participants in behavioural medical rehabilitation reported better self-rated work ability, physical functioning and self-management skills, and decreased pain disability and fear-avoidance beliefs 10 months after rehabilitation. Standardized effect sizes were between 0.13 and 0.22.ConclusionBehavioural medical rehabilitation had no clinical meaningful effect on maintaining and restoring work ability. However, behavioural medical rehabilitation affected pain and disease management skills 10 months after completing the rehabilitation programme.LAY ABSTRACTMental health comorbidity increases the risk for patients with musculoskeletal disorders to receive a disability pension despite participating in a multimodal rehabilitation programme. In Germany, behavioural medical rehabilitation programmes were therefore developed for people who are affected from both musculoskeletal and mental health disorders. These programmes integrate additional psychological treatment into the standard multimodal rehabilitation approach. To test whether these programmes are more effective in enabling a stable return to work and improving self-rated health, this study compared 360 patients treated in behavioural medical rehabilitation with 360 comparable controls treated in conventional medical rehabilitation. The results indicate that participants could benefit more from a behavioural medical rehabilitation programme. Patients did not return to work significantly more often. However, they reported better self-rated work ability, better pain and health-related outcomes, and fewer days with unemployment benefits. In conclusion, more consistent implementation of the programme offers the opportunity to further improve these outcomes.

Use of complementary and alternative medicine and low quality of life associate with the need for psychological and psychotherapeutic interventions in inflammatory bowel disease.

IntroductionPatients with inflammatory bowel disease (IBD) suffer from various symptoms, impairing their quality of life and often affecting psychosocial issues. This may lead to the need for additional psychological care. This study investigated patients' subjective need for integrated psychosomatic support and psychotherapy and indicators for it.Materials and methodsThis is a cross‐sectional multicentre study in Austrian IBD patients who were in routine care at 18 IBD outpatient clinics. Patients filled in an anonymous, validated questionnaire (Assessment of the Demand for Additional Psychological Treatment Questionnaire [ADAPT]) assessing the need for psychological care. The ADAPT gives two separate scores: the need for integrated psychosomatic support and for psychotherapy. In addition, health‐related quality of life and the use of complementary and alternative medicine as well as clinical and socio‐demographic variables were queried. Multivariable regression analysis was performed to estimate the effect of the previously mentioned variables on the need for additional psychological care.ResultsOf 1286 patients, 29.7% expressed a need for additional psychological care, 19.6% expressed a need for integrated psychosomatic support and 20.2% expressed a need for psychotherapy. In the multivariable analysis, the two strongest indicators for the need for both types of psychological care were the use of complementary and alternative medicine (for integrated psychosomatic support: odds ratio = 1.64, 95% confidence interval 1.13–2.39, p = 0.010; for psychotherapy: odds ratio = 1.74, 95% confidence interval 1.20–2.53, p = 0.004), and a low health‐related quality of life score (for integrated psychosomatic support: odds ratio = 0.95, 95% confidence interval 0.94–0.96, p < 0.001; for psychotherapy: odds ratio = 0.96, 95% confidence interval 0.94–0.97, p < 0.001).DiscussionAbout 30% of the Austrian IBD patients expressed a need for integrated psychosomatic support and/or psychotherapy. The most important indicators for this need were the use of complementary and alternative medicine and low quality of life.

Transdiagnostic treatment of emotional disorders for women with multiple sclerosis: a randomized controlled trial

BackgroundMultiple sclerosis (MS) is a chronic, unpredictable, neurodegenerative disease, significantly associated with psychological, behavioral, cognitive, and emotional consequences. MS is more common in females than males and frequently affects women during their reproductive years. Despite the frequent mental disorders, comorbidities, and emotional problems in People with MS (PwMS), these conditions are too often underdiagnosed and undertreated.ObjectiveThis study aimed to examine the efficacy of a group format of the Unified Protocol (UP) for the Transdiagnostic treatment of depression and anxiety disorders in females with MS.MethodsIn the present study, Sixty-four adult females diagnosed with MS were randomized to either the UP (n = 32) or treatment-as-usual conditions. The assessment protocol included semi-structured clinical interviews and self-reports evaluating diagnostic criteria, depression, anxiety and worry symptoms, emotional regulation, and affectivity.ResultsRepeated measure analysis of variance (ANOVA) revealed that the UP significantly improved depression scores [Cohen’s d = − 2.11, 95% CI (− 2.72, − 1.50)], anxiety scores [Cohen’s d = − 3.34, 95% CI (− 4.01, − 2.58)], positive and negative affect scale (PANAS)-positive affect scores [Cohen’s d = 1.46, 95% CI (1.46, 2.01)], PANAS-negative affect scores [Coen’s d = − 2.21, 95% CI (− 2.84, − 1.60)], difficulties emotion regulation scale scores [Cohen’s d = 1.40, 95% CI (− 0.87, − 0.03)], and Worry scale scores [Cohen’s d = − 0.45, 95% CI (− 0.95, − 0.04)] at the end of treatment relative to compared to the control condition. Also, treatment gains were maintained at the three-month follow-up (p < 0.001).ConclusionThe findings provide the support that the UP could be an additional efficient psychological treatment for females with MS.ISRCTN Number: ISRCTN95459505.

Transdiagnostic treatment of emotional disorders in people with multiple sclerosis: randomized controlled trial

BackgroundMultiple sclerosis (MS) is a neurodegenerative disease of the central nervous system. MS is significantly associated with a high rate of psychological, behavioral, and emotional consequences. Despite the frequent mental disorders, high rate of psychological comorbidities, and emotional problems in people with MS (PwMS), these conditions are often underdiagnosed and undertreated. This study aimed to examine the efficacy of a group format of the unified protocol for the transdiagnostic treatment of emotional disorders in adult PwMS associated with an emotional disorder.MethodsSeventy adult PwMS were randomized using an internet-based computer system to either the unified protocol (n = 35) or treatment as usual condition. The assessment protocol included semi-structured clinical interviews and self-reports evaluating diagnostic criteria, depression, anxiety and worry symptoms, emotional dysregulation, and affectivity.ResultsThe parametric test of analysis of covariance, followed the intent to treat analyses, revealed the unified protocol significantly changed depression symptoms (Cohen’s d = 1.9), anxiety symptoms (Cohen’s d = 2.16), worry symptoms (Cohen’s d = 1.27), emotion dysregulation (Cohen’s d = 0.44), positive affect (Cohen’s d = 1.51), and negative affect (Cohen’s d = 1.89) compared with the control group. The unified protocol also significantly improved outcome scores at the end of treatment relative to baseline (p < .001).ConclusionThe findings support that the unified protocol could be an additional efficient psychological treatment for PwMS.Trial registration IRCT, number: IRCT20190711044173N1. Registered 31october 2019, https://en.irct.ir/user/trial/40779/view.

Transferring Postbariatric Patients to Primary Care: A Regionwide Analysis

Background: The provision of a postbariatric multidisciplinary long-term follow-up is recommended, however challenging. Methods: Multidisciplinary teams of two centers, a multi-institutional center for diagnostics and representatives of general practitioners in a Dutch metropole region composed a transmural protocol for transferring bariatric patients 2 years postoperatively to primary care. The quality of these transfers was measured by medical outcomes, quality of life, satisfaction, laboratory results, and re-referrals. Results: Two hundred twenty-two patients were referred according to protocol of which 150 patients were sent beyond 5 years postbariatric. For 11 patients the outcomes were not provided, 3 untraceable, and 11 no-shows, leaving a total of 47 patients for evaluation. Laboratory results were discussed in 32 patients, the psychologic screening questionnaire in 7 patients. It led to referral to the obesity center in six and to additional psychological treatment in four cases. The average satisfaction was graded 6.8. Conclusions: A disappointing low portion of patients was referred to primary care still resulting in an incomplete follow-up. The composition of a transmural protocol by all caretakers did increase the first-level knowledge. The authors assume that this is beneficial for long-term referrals; however, obesity teams should focus on adherence in the first 5 years at a bariatric center.

Quality of life in inflammatory bowel diseases: it is not all about the bowel.

Background/AimsThe inflammatory bowel diseases (IBD), ulcerative colitis (UC), and Crohn’s disease (CD) are chronic diseases mostly affecting young patients. As they are diseases accompanying patients for their entire life, and the quality of life (QUOL) interacts with disease activity, improving QUOL should be one of the main goals of therapy. This study aims to identify factors contributing to good or impaired QUOL.MethodsQuestionnaires addressing health-related QUOL and other psychological and social features were positioned on our institutions’ webpage and on the webpage of the largest self-help group for IBD in Germany. Patients were subdivided according to their QUOL score with a cutoff of <60. We used the Short Inflammatory Bowel Disease Questionnaire, the Assessment of the Demand for Additional Psychological Treatment, and the Fear of Progression Questionnaire Short Form.ResultsHigh numbers of patients in both subgroups showed an impaired QUOL (87.34% in UC, 91.08% in CD). Active extraintestinal manifestations, smoking, high fear of progression and high demand for psychotherapy were associated with reduced QUOL. In addition, polypharmacological interventions did not result in a good QUOL, but ostomies are linked to improved QUOL especially in CD patients.ConclusionsScores used in clinical day-to-day-practice mainly focusing on somatic factors do not sufficiently address important aspects concerning QUOL. Most importantly, extraintestinal manifestations show a hitherto underestimated impact on QUOL.

Prognostic model for psychological outcomes in ambulatory surgery patients: A prospective study using a structural equation modeling framework.

IntroductionSurgical procedures are increasingly carried out in a day-case setting. Along with this increase, psychological outcomes have become prominent. The objective was to evaluate prospectively the prognostic effects of sociodemographic, medical, and psychological variables assessed before day-case surgery on psychological outcomes after surgery.MethodsThe study was carried out between October 2010 and September 2011. We analyzed 398 mixed patients, from a randomized controlled trial, undergoing day-case surgery at a university medical center. Structural equation modeling was used to jointly study presurgical prognostic variables relating to sociodemographics (age, sex, nationality, marital status, having children, religion, educational level, employment), medical status (BMI, heart rate), and psychological status associated with anxiety (State-Trait Anxiety Inventory (STAI), Hospital Anxiety and Depression Scale (HADS-A)), fatigue (Multidimensional Fatigue Inventory (MFI)), aggression (State-Trait Anger Scale (STAS)), depressive moods (HADS-D), self-esteem, and self-efficacy. We studied psychological outcomes on day 7 after surgery, including anxiety, fatigue, depressive moods, and aggression regulation.ResultsThe final prognostic model comprised the following variables: anxiety (STAI, HADS-A), fatigue (MFI), depression (HADS-D), aggression (STAS), self-efficacy, sex, and having children. The corresponding psychological variables as assessed at baseline were prominent (i.e. standardized regression coefficients ≥ 0.20), with STAI-Trait score being the strongest predictor overall. STAI-State (adjusted R2 = 0.44), STAI-Trait (0.66), HADS-A (0.45) and STAS-Trait (0.54) were best predicted.ConclusionWe provide a prognostic model that adequately predicts multiple postoperative outcomes in day-case surgery. Consequently, this enables timely identification of vulnerable patients who may require additional medical or psychological preventive treatment or–in a worst-case scenario–could be unselected for day-case surgery.

Cognitive therapy and exposure therapy for hypochondriasis (health anxiety): A 3-year naturalistic follow-up.

Cognitive-behavioral therapy (CBT) has been shown to be effective in treating hypochondriasis. However, there are doubts regarding the long-term effectiveness of CBT for hypochondriasis, in particular for follow-up periods longer than 1 year. The aim of the present study was to evaluate the long-term effectiveness of cognitive therapy (CT) and exposure therapy (ET) for the treatment of hypochondriasis. Seventy-five patients with a diagnosis of hypochondriasis who were previously treated with CT or ET were contacted 3 years after treatment. Fifty (67%) patients participated and were interviewed by an independent and blinded diagnostician using standardized interviews. We found further improvements after therapy in primary outcome measures (d = .37), general functioning (d = .38), and reduced doctor visits (d = .30) during the naturalistic follow-up period. At the 3-year follow-up, 72% of the patients no longer fulfilled the diagnosis of hypochondriasis. Based on the main outcome measure, we found response rates of 76% and remission rates of 68%. At follow-up, only 4% of patients were taking antidepressant medication. Additional psychological treatment was utilized by 18% of the patients during the follow-up period (only 8% because of health anxiety). We found no overall differences between CT and ET. Only a trend for a greater deterioration rate in CT (13%) in comparison to ET (0%) was found. Our results suggest that ⅔ of the patients with hypochondriasis were remitted in the long term. Thus, remission rates after CBT were twice as high as in untreated samples. (PsycINFO Database Record

Assessment of the need for psychosomatic care in patients with suspected cardiac disease.

The study aimed to assess the subjectively perceived need for additional general disease-oriented and psychotherapeutic care in patients with suspected cardiac disease and to investigate if the request for additional care is consistent with impairment of generic quality of life and the presence of psychosomatic risk factors. Patients referred for cardiac stress testing because of suspected cardiac disease completed the assessment of the demand for additional psychological treatment (ADAPT) questionnaire, an assessment tool for counselling demand in patients with chronic illness, the SF-36 quality of life and the hospital anxiety and depression scale (HADS) questionnaires. The questionnaires were administered to 233 patients (age: 54.5 ± 13.4, 57.5% male). Exclusivedemand for disease-oriented counselling was indicated by 45.1%, demand for psychotherapeutic counselling (exclusive or combined with disease-oriented demand) by 33.9%. Almost all patients with psychotherapeutic demand(96.3%) expressed also request for disease-orientedcounselling. Patients with exclusive demand for disease-orientedcounselling showedsignificantly lower scores in the emotional and physical functioning and role domains of the SF-36 than the norm population.Patients demanding psychotherapeutic counselling reported significantly lower scores in all SF-36 domains than the norm population. Psychotherapeutic demand was strongly associated with positive indicators for mental distress: SF-36 MH (OR:4.1), SF-36 MCS (OR:5.9), HADS anxiety (OR:3.9), and HADS depression (OR:3.0). Our study shows that the patients' request for additional care reflects impairment of generic health status and psychological risk load. This indicates that the assessment of subjectively perceived demand allows to screen for patients who are in need of psychosomatic care and motivated to participate in additional counselling and therapy.

The suitability of the Hospital Anxiety and Depression Scale, Distress Thermometer and other instruments to screen for psychiatric disorders in both lung cancer patients and their partners

BackgroundLung cancer patients and their partners report high rates of distress. Although distress is of importance, psychiatric disorders might be more important in terms of prognostic value and additional psychological treatment. This study examined the suitability of the Hospital Anxiety and Depression Scale (HADS), Distress Thermometer (DT), Beck Depression Inventory (BDI-II) and State subscale of State Trait Anxiety Inventory (STAI-S) to screen for psychiatric disorders in lung cancer patients and partners. MethodsA consecutive sample of lung cancer patients and partners completed the screening instruments. The Structured Clinical Interview DSM-IV (SCID-I) was used to diagnose psychiatric axis I disorders. ResultsIn 144 patients, overall ability of HADS total score (HADS-T) screening for patients with psychiatric disorders was good, whereas DT appeared less suitable. In 98 partners, the performance of HADS-T was good. Although no instrument was successful in identifying psychiatric disorders, HADS-T came closest with a fair performance in patients and partners. LimitationsSeveral patients and partners declined participation because they perceived participation as too distressing. As decliners possibly have the highest rates of disorders, our findings might underestimate the prevalence of psychiatric disorders. A low prevalence negatively affects the positive predictive value and complicates efficient screening for psychiatric disorders. ConclusionThe HADS-T appears to be a suitable screening instrument for ruling out those lung cancer patients and partners without a psychiatric disorder. Regarding identifying those with a psychiatric disorder, HADS-T should be used to refer both patients and partners for further diagnostics and treatment to a psychiatrist/psychologist.

Self-reported need for psychotherapy predicts interferon-induced depression in hepatitis C: stratification for interferon-free treatment.

Interferon (IFN)-induced depression occurs in approximately 30% of chronic hepatitis C (CHC) patients undergoing pegylated (PEG)-IFN-based antiviral therapy. While IFN-free therapy has been developed, it is not accessible to all CHC patients due to the high costs of treatment. This study evaluated the Assessment of Demand for Additional Psychological Treatment (ADAPT) questionnaire as a screening tool for patients at risk of IFN-induced depression, in order to identify patients who may uniquely benefit from IFN-free regimens. In this prospective study, consecutive patients being treated for CHC with PEG-IFN-based antiviral therapy were examined for the occurrence of depression during a 12-week treatment period. Using univariate and multivariate regression models, the value of the ADAPT questionnaire, in comparison to the Hospital Anxiety and Depression Scale (HADS), and the patients' psychiatric history was analysed. A total of 103 patients (59% male; median age 42) were included, of whom 25% (26/103) developed IFN-induced depression during the study period. HADS-Depression (D) subscale (OR=1.187, P=0.003; area under the curve [AUC]=0.690) and ADAPT-Psychotherapy (PT) subscale (OR=1.020, P=0.006; AUC=0.695) showed the highest accuracy for identification of patients at risk for depression. A HADS-D score of ≥7 and an ADAPT-PT score of ≥37.8 showed a similar sensitivity (61.5% versus 57.7%), whereas ADAPT-PT showed a more favourable specificity (68.9% versus 77.4%). The ADAPT-PT subscale effectively identifies patients at risk for IFN-induced depression and should therefore be taken into account when allocating patients to IFN-free antiviral treatment regimens.

Comorbid Anxiety Disorders in Canadians with Bipolar Disorder: Clinical Characteristics and Service Use

To examine the impact of anxiety disorders comorbid to bipolar disorder (BD) in a large, nationally representative sample, to describe the sociodemographic and clinical profiles of Canadians living with BD and with or without comorbid anxiety disorders, to identify the characteristics uniquely associated with comorbid anxiety, and to examine treatment patterns. We analyzed data from the Canadian Community Health Survey: Mental Health and Well-Being, conducted among 38 492 Canadians. People meeting the criteria for BD (n = 808) were compared based on the presence or absence of an assessed anxiety disorder (that is, social phobia, panic disorder, and agoraphobia). People with BD and a comorbid anxiety disorder fare worse in terms of BD relapses, suicidality, and sleep disturbance, and are more likely to be taking psychiatric medication. They have more impairment in their work and social functioning and rate their health and life satisfaction lower. Despite the greater severity, they are not receiving additional psychological treatment, they feel they are not receiving the treatment they need, and they report more barriers to treatment. This study confirms the critical impact of comorbid anxiety on the course of BD in a large, nationally representative sample and reveals that the psychological treatment needs of this population are not being met. Clinical and research implications are discussed.

Psychological aspects affect quality of life in patients with oral squamous cell carcinomas

Quality of life (QoL) in head and neck cancer patients has been of increasing interest for some years. Unfortunately, only poor data exist regarding the impact of professional psychological support on QoL. The purpose of this study was to investigate psychological aspects of QoL as well as the potential need for additional psychological treatment. A total collective of 1761 patients from 38 hospitals yielding 1652 patients' questionnaires containing 147 items was evaluated. QoL, impairments and psychological and surgical treatment were evaluated. Most patients had no psychological interview, and the majority of those who had an interview did not even want one. However, 17% of those patients who did not receive an interview wished to have one. When a psychological interview was performed, most patients (77.5%) evaluated this as helpful. Patients who wished to have a psychological interview but did not receive one showed a significantly worse QoL than those patients without a wish for such an interview. Moreover, having an interview, which does not meet the needs of the patients, diminishes QoL compared with not having an interview. Taken together, these findings emphasise the impact of psychological treatment at least on a significant number of head and neck cancer patients.

A Randomized Controlled Trial of Secondary Prevention of Anxiety and Distress in a German Sample of Patients With an Implantable Cardioverter Defibrillator

To evaluate a minimal, easy, accessible intervention targeting anxiety and reduced quality of life in patients with an implantable cardioverter defibrillator (ICD). An estimated 24% to 87% of patients experience anxiety, and 10% to 15% have reduced quality of life. A total of 119 ICD patients were assigned randomly to usual medical aftercare (n = 63) or additional psychological treatment (n = 56) comprising of written information on medical and psychological consequences of an ICD plus 6 months of individual phone counseling. Treatment efficacy was evaluated by comparing T0 (immediately after implantation) and T1 (6 months later) assessments. Although 75% of patients considered the program helpful, age moderated treatment efficacy. As indicated by triple interactions, only in the treatment group, anxiety (HADS-Anxiety, p < .01), psychological distress (SCL-K-9, p < .02), and somatic quality of life (SF-36-PCS, p < .01) improved in ICD patients aged <65 years but deteriorated in older patients (age, 65-75 years). Frequency of ICD discharges was associated with a symptom increase from T0 to T1 in all patients (HADS-Depression, CAQ-Avoidance, and ICD-Constraints; all p < .05). Our findings confirm that psychological treatments cannot be expected to have uniformly positive effects in ICD patients. Our minimal intervention may have adequately addressed ICD-related concerns in younger patients but may have fostered problems in older patients with fewer concerns. Therefore, our findings warrant custom treatment with particular attention to the elderly as well as patients with frequent ICD discharges.

119 – Pre-morbid and outcome correlates of sexual and physical trauma in first episode psychosis (FEP) patients

Background: Incidence of trauma is known to be higher in patients with psychosis compared to general population. Little is known on its impact in the pre-morbid phase of psychosis and on outcome after a first psychotic episode. Methods: Medical records review of patients treated at EPPIC between 1998 and 2000. Comparison between patients who had been exposed either to physical or to sexual trauma and those who had not been exposed to such events. Results: Information on trauma was available for 658 FEP patients: 26% had been exposed to physical abuse and 16% to sexual abuse. Characteristics linked with past sexual abuse were schizophrenia diagnosis, female gender, substance abuse co-morbidity, history of previous treatment for psychiatric disorder and suicide attempt before FEP, as well as higher rate of admissions and suicide attempts during treatment. Characteristics linked with past history of physical abuse were schizophrenia diagnosis, substance abuse co-morbidity, history of previous treatment for psychiatric disorder and suicide attempt before FEP, as well as higher rate of non-adherence to treatment, suicide attempts during treatment and persistence of psychotic symptoms after 18 months. Conclusions: Sexual and physical traumas are highly prevalent in FEP patients and have an important impact both before and after FEP. Life history of such events needs to be explored by clinicians, and impact of additional psychological treatment needs to be studied, in order to develop strategies that may limit consequences of past trauma and decrease risk of suicide.

Modification of Coronary-Prone Behaviors in Coronary Patients of Low Socio-Economic Status

The purpose of this study is to determine the effectiveness of a group cognitive-behavioral treatment to modify coronary-prone behaviors in patients from a fairly low social and educational level. Participants were 98 male coronary patients randomly allocated to one experimental and two control groups. All groups received standard medical treatment. The experimental group received an additional psychological treatment and one of the two control groups received a health education treatment. Results showed that only the psychological treatment group significantly reduced Pressured Drive and Speed-Impatience after treatment, and at 1- and 2-year follow-ups. Depression was also significantly reduced only in this group at 2-year follow-up. The results are considered a reliable first step in the process of validating this program designed to improve coronary heart disease patients' quality of life.

Childhood Sexual Abuse is not Associated with a Poor Outcome after Gastric Banding for Severe Obesity

The aim of this study was to examine whether a history of childhood sexual abuse is associated with weight, health, and depression after Laparoscopic Adjustable Gastric Banding for severe obesity. 157 patients (144 female, 13 male) filled out questionnaires on average 34 months after surgery (range 8-68 months). 23% of the participants, all women, reported a history of childhood sexual abuse. There were no differences between patients with and without a history of childhood sexual abuse on weight and physical health, but the group with a history of childhood sexual abuse showed a higher level of depression. A reported history of childhood sexual abuse does not appear to impact on weight outcome after bariatric surgery, but some patients may need additional psychological treatment for their mental health problems.