Changes In Psychiatric Symptoms Research Articles

H06 Longitudinal Psychiatric Symptoms in Premanifest HD: Psychiatric Progression and Unawareness in a Decade of Data

Background Huntington Disease (HD) is an autosomal dominant neurodegenerative disease that typically manifests with motor, cogniti1ve and psychiatric symptoms. The majority of research emphasises the motor and cognitive phenotype of HD. Cross-sectional research consistently shows increased psychiatric and behavioural impairments in HD although few studies have examined longitudinal changes in psychiatric symptoms. Aims Here we report longitudinal behavioural data with up to ten years of follow-up to identify behavioural changes that occur in premanifest HD up to and through motor conversion. Methods Using the Symptom Check List-90-Revised (SCL90), a 90-item self-report scale of psychological symptomatology, we analysed data from 1305 participants (cases and controls) with 6112 observations and their 1235 companions with 5365 observations. Individuals with CAG repeat expansion (CAG≥36) served as cases while people who tested negative for the expansion (CAG Results Of the 24 psychiatric outcome variables examined, 19 showed significant baseline and longitudinal differences between cases and controls. Further, when analyses were conducted to examine ratings between cases and companions, findings showed inconsistency between the raters that is interpreted in terms of unawareness associated with HD progression. Conclusions In cases near motor onset, companion ratings appear to be more valid than patient-report. Our findings indicate that unawareness increases in concert with disease progression during premanifest stages. Psychiatric disturbances demonstrate worsening over time in concert with disease progression in HD.

The effectiveness of integrated treatment in patients with substance use disorders co-occurring with anxiety and/or depression - a group randomized trial

BackgroundIntegrated Treatment (IT) has proved effective in treating patients with Substance Use Disorders (SUD) co-occurring with severe Mental Disorders (MD), less is known about the effectiveness of IT for patients with SUD co-occurring with less severe MD.The aim of this study was to investigate the effectiveness of IT for patients with SUD co-occurring with anxiety and/or depression on the following parameters:1. The use of substances, as measured by the Alcohol Use Identification Test (AUDIT), the Drug Use Identification Test (DUDIT), and the Addiction Severity Index (EuropASI).2. The severity of psychiatric symptoms, as measured by the Symptom Check List 90 r (SCL 90R).3. The client’s motivation for changing his/her substance use behaviour, as measured by the Substance Abuse Treatment Scale (SATSr).MethodsThis is a group randomized clinical trial comparing the effectiveness of IT to treatment as usual in Community Mental Health Centres (CMHCs). Five CMHCs were drawn to the Intervention Group (IG) and four CMHCs to the Control Group (CG). The allocation to treatment conditions was not blinded. New referrals were screened with the AUDIT and the DUDIT. Those who scored above the cut-off level of these instruments were assessed with the Structured Clinical Interview for DSM-IV 1 and 2. We included patients with anxiety and/or depression together with one or more SUDs.ResultsWe included 55 patients in the IG and 21 in the CG. A linear multilevel model was used. Both groups reduced their alcohol and substance use during the trial, while there was no change in psychiatric symptoms in either group. However, the IG had a greater increase in motivation for substance use treatment after 12 months than had the CG with an estimate of 1.76, p = 0.043, CI95% (0.08; 3.44) (adjusted analyses). There were no adverse events.ConclusionsIntegrated treatment is effective in increasing the motivation for treatment amongst patients with anxiety and/or depression together with SUD in outpatient clinics.Trial registrationClinicalTrials.gov: NCT00447733.

Prospective Associations Between the Family Environment, Family Cohesion, and Psychiatric Symptoms Among Adolescent Girls

The present study used a longitudinal design to investigate whether parental values, interests, and the perceived level of expressiveness, cohesiveness and control in the family were associated with changes in psychiatric symptoms during early adolescence. We used data gathered at ages 12, 14 and 17 from 1,600 adolescent girls in the National Heart, Lung and Blood Institute Growth and Health Study. Using a novel approach we found significant informant effects of family cohesion on psychiatric symptoms, with stronger associations for adolescent ratings than parental ratings. Multivariate modelling adjusting for family cohesion (from parents and adolescents perspective), and parents' depressive and eating disorder symptoms indicated parental ratings on the intellectual and cultural orientation of the family predicted small but significant increases in eating disorder symptoms, anxiety and a reduction in self-worth 2-years later. Parental control also predicted a reduction in anxiety and family expressiveness was related to increases in self-worth.

Network coordination following discharge from psychiatric inpatient treatment: a study protocol

BackgroundInadequate discharge planning following inpatient stays is a major issue in the provision of a high standard of care for patients who receive psychiatric treatment. Studies have shown that half of patients who had no pre-discharge contact with outpatient services do not keep their first outpatient appointment. Additionally, discharged patients who are not well linked to their outpatient care networks are at twice the risk of re-hospitalization. The aim of this study is to investigate if the Post-Discharge Network Coordination Program at ipw has a demonstrably significant impact on the frequency and duration of patient re-hospitalization. Subjects are randomly assigned to either the treatment group or to the control group. The treatment group participates in the Post-Discharge Network Coordination Program. The control group receives treatment as usual with no additional social support. Further outcome variables include: social support, change in psychiatric symptoms, quality of life, and independence in daily functioning.Methods/designThe study is conducted as a randomized controlled trial. Subjects are randomly assigned to either the control group or to the treatment group. Computer generated block randomization is used to assure both groups have the same number of subjects. Stratified block randomization is used for the psychiatric diagnosis of ICD-10, F1. Approximately 160 patients are recruited in two care units at Psychiatrie-Zentrum Hard Embrach and two care units at Klinik Schlosstal Winterthur.DiscussionThe proposed post-discharge network coordination program intervenes during the critical post-discharge period. It focuses primarily on promoting the integration of the patients into their social networks, and additionally to coordinating outpatient care and addressing concerns of daily life.Trial registrationISRCTN: ISRCTN58280620

Treatment of antipsychotic-induced hyperprolactinemia with bromocriptine: A case report

INTRODUCTION Previous literature has highlighted an increase in morbidity and mortality associated with antipsychotic use in persons with severe mental illnesses (SMI), which include schizophrenia and bipolar disorder. Drug-induced hyperprolactinemia is a function of dopamine blockade in the anterior pituitary. Elevated prolactin levels are often accompanied by symptoms of decreased libido and erectile dysfunction (ED) in men, and galactorrhea and amenorrhea in women. However, the extent to which antipsychotic (AP) use is associated with sexual dysfunction has not been extensively reported. Hyperprolactinemia may also increase the risk for osteopenia.

955 – Long-term effectiveness of long- and short-term psychotherapy in the treatment of depressive and anxiety disorders

Introduction Little is known about long-term effects of psychotherapy on depressive or anxiety disorders. Aims To compare the effectiveness of three psychotherapies of different length in a clinical trial with a 5-year follow-up. Methods In the Helsinki Psychotherapy Study, 326 outpatients with mood or anxiety disorder were randomly assigned to longterm psychodynamic psychotherapy (LPP), short-term psychodynamic psychotherapy (SPP), and solution-focused therapy (SFT), and were followed up for 5 years from start of treatment. Depressive, anxiety and general psychiatric symptoms (BDI, SCL-90-Anx, and SCL-90-GSI), working ability (WAI), and recovery (based on changes in psychiatric symptoms and use of auxiliary treatment) were used as outcome measures. Results For patients with depressive disorder LPP was more effective than SPP or SFT in reducing symptoms, improving work ability and leading to recovery during the 3 last years of follow-up. For patients with anxiety disorder effectiveness of LPP was less pronounced with no differences between short-term and long-term therapy in recovery from anxiety symptoms. No differences were found between the effectiveness of the short-term therapies. Conclusions Long-term psychotherapy is more effective than short-term therapy during a long follow-up especially in the treatment of depressive disorder. More research especially considering different anxiety disorders is still needed.

Psychological predictors of the recovery from mood or anxiety disorder in short-term and long-term psychotherapy during a 3-year follow-up

Choice of optimal treatment length for psychiatric patients requires knowledge about the patients' pre-treatment suitability. This study compares the prediction of seven psychological suitability measures on changes in psychiatric symptoms in short- and long-term psychotherapy over a 3-year follow-up. The psychological suitability of 326 outpatients from the Helsinki Psychotherapy Study, aged 20–46 years, and suffering from mood or anxiety disorders, was assessed at baseline using the Suitability for Psychotherapy Scale (SPS) before randomly assigning them to solution-focused therapy, short-term or long-term psychodynamic psychotherapy. Psychiatric symptoms (Symptom Checklist-90 Global Severity Index) were assessed at baseline and seven times during follow-up. Three patient groups with different prognosis were found when a cumulative SPS score, summing up the values of the seven single suitability measures, was used to predict symptom development: patients with more good (4 or more) than poor values benefited more from short-term therapy, patients with more poor (4–6) than good values benefited more from long-term therapy, and patients with all seven values poor failed to benefit from either short- or long-term therapy. The SPS can apparently be applied before the start of treatment to predict the amount of therapy patients need to recover, although its suitability in therapies of different types needs to be confirmed.

Psychological Outcomes and Predictors of Initial Weight Loss Outcomes Among Severely Obese Adolescents Receiving Laparoscopic Adjustable Gastric Banding

Elevated rates of psychopathology are noted among severely obese youth presenting for weight loss surgery. The role of mental health providers in this population is not well defined, and the selection of candidates is often the result of clinical judgment alone. The purpose of this study was to comprehensively evaluate psychiatric symptoms among a large sample of adolescents receiving laparoscopic adjustable gastric banding (LAGB) by (1) examining changes in depressive symptoms and quality of life in the year following surgery; (2) evaluating the interaction between patterns of change in depression, quality of life, and weight postsurgery; and (3) identifying presurgical psychological predictors of initial weight change. Participants were 101 severely obese adolescents aged 14 to 18 years receiving LAGB at the Center for Adolescent Bariatric Surgery at the Morgan Stanley Children's Hospital of New York Presbyterian/Columbia University Medical Center between August 2006 and December 2009. Measures of height, weight, depressive symptoms, and quality of life were obtained in the first year following surgery. Changes in the Beck Depression Inventory (BDI), Pediatric Quality of Life Inventory (PedsQL), and body mass index were analyzed using latent growth curve modeling. Short-term changes in psychiatric symptoms and weight were analyzed using latent growth curve modeling. Significant changes in total BDI (βslope = -0.885, SE = 0.279, P < .01; βquadratic = 0.054, SE = 0.021, P < .001) and PedsQL (βslope = -0.885, SE = 0.279, P < .001) scores were observed following LAGB, and comparable postoperative changes between psychosocial variables and body mass index were also noted (BDI: covariance [COV] = 0.21, SE = 0.06, P < .001; PedsQL: COV = -0.41, SE = 0.10, P < .01). Two variables (family conflict/loss of control eating) were found to be significant predictors of weight change over the year following surgery (P < .05). Adolescents experienced notable improvements in initial depressive symptoms and quality of life after LAGB, and measures of preoperative binge eating and family conflict affected postsurgery body mass index among youth. ClinicalTrials.gov identifier: NCT01045499.

Randomized trial on the effectiveness of long- and short-term psychotherapy on psychiatric symptoms and working ability during a 5-year follow-up

Background: The information on whether long-term psychotherapy is superior in comparison with short-term therapies during a long time-perspective in the treatment of mood and anxiety disorder is incomplete. Aims: The present study addresses this question in a clinical trial with an exceptionally long follow-up. Methods: In the Helsinki Psychotherapy Study, 326 outpatients with mood or anxiety disorder were randomly assigned to long-term psychodynamic psychotherapy and two types of short-term psychotherapy (short-term psychodynamic psychotherapy and solution-focused therapy) and were followed up for 5 years from the start of treatment. The outcome measures were psychiatric symptoms measured by Beck Depression Inventory (BDI), Hamilton Depression Rating Scale (HDRS), Symptom Check List, anxiety scale (SCL-90-Anx), Hamilton Anxiety Rating Scale (HARS) and Symptom Check List, Global Severity Index (SCL-90-GSI), and working ability measured by the Work Ability Index (WAI), the Work-subscale (SAS-Work) of the Social Adjustment Scale (SAS-SR) and the Perceived Psychological Functioning Scale (PPF). Furthermore, remission variables based on changes in psychiatric symptoms and use of auxiliary treatment, were used. Results: After the 5-year follow-up, the rate of recovery from psychiatric symptoms and the work ability improvement rate remained higher in the long-term therapy group, whereas no differences in the effectiveness of the two short-term therapies of different modalities were found. Conclusions: Long-term psychotherapy is more effective than short-term therapy during a long follow-up, suggesting the need for a careful evaluation of suitability to short-term therapy. More research on the long-term effects of psychotherapy in large-scale studies is still needed, however.

Prediction of the outcome of short- and long-term psychotherapy based on socio-demographic factors

Socio-demographic factors predict the outcome of short-term psychotherapy (STT) in the treatment of mood and anxiety disorders, but information on the prediction for long long-term therapy (LPP) is lacking. We aimed to compare the prediction of changes in psychiatric symptoms afforded by socio-demographic factors across two treatment conditions, short- versus long-term psychotherapy. In the Helsinki Psychotherapy Study, 326 outpatients with mood or anxiety disorders, aged 20-46 years, were randomly assigned to STT or LPP. Socio-demographic factors (i.e. age, gender, education, employment status, marital status, and living arrangement) were self-reported. Psychiatric symptoms were measured by the Symptom Check List, Global Severity Index (SCL-90-GSI) and Anxiety scale (SCL-90-Anx), and the Beck Depression Inventory (BDI) at baseline and seven times during a three-year follow-up period. Socio-demographic factors were found to predict symptom development during follow-up irrespective of the baseline symptom level. Patients in a relatively good position, i.e. married and highly educated patients benefited from STT, whereas patients in less advantaged positions, i.e. homemakers, lone parents, and divorced patients needed LPP or did not benefit from either therapy. In several categories of socio-demographic factors, the extent to which a patient's background predicted the outcome of the psychotherapy varied according to whether general, anxiety or depressive symptoms were studied. We were unable to assess widows and pensioners. For ethical reasons, a no-treatment control group with a long follow-up could not be included in the study design. Socio-demographic factors may need to be considered in the selection of patients for short- and long-term therapy.

Anxiety in Predicting Suicide-Related Symptom of Typhoon Disaster Victims: A One-Year Follow-Up Study in Southern Taiwan

The aim of this study was to screen those at high risk of psychological distress in areas affected by typhoon Morakot, which hit Taiwan on August 7th, 2009. Screening was conducted a year later to assess the changes in psychiatric symptoms and investigate the factors which may be predictive of psychological distress and suicide ideation. One-hundred and fifty-two participants were collected at the first screening and 125 a year later. The five-item Brief Symptom Rating Scale was used to measure the level of psychological distress. Our results showed the prevalence of psychological distress immediately post-disaster was 2.4% and increased to 4.0% the next year. The level of anxiety post-disaster could predict continuous psychological distress and the development of suicidal ideation a year later. Traumatic events prior to the typhoon were not associated with the level of psychological distress a year after the disaster. Difference was found in the level of hostility immediately post-disaster and a year later. Our follow-up study found anxiety was the only indicator which predicted psychological distress a year later, and hostility was a transient state which was lower a year after the disaster. Policy-makers and future programs should focus on high anxiety cases post-disaster to prevent mental symptom and suicide ideation development.

Self-esteem as a mediator of the relationship between role functioning and symptoms for individuals with severe mental illness: A prospective analysis of Modified Labeling theory

BackgroundDespite a growing body of evidence supporting the efficacy of psychosocial rehabilitation for individuals with severe mental illness (SMI), a large proportion of these individuals remain unable to maintain basic social roles such as employee, parent, or spouse. This study investigated whether changes in role functioning over time impact symptom severity indirectly through the mechanism of changes in self-esteem as posited by Modified Labeling theory. MethodsThe study sample was composed of 148 individuals diagnosed with schizophrenia, schizoaffective disorder, bipolar disorder with psychotic features, and major depression with psychotic features who elected to participate in community-based psychosocial rehabilitation services. Measures of role functioning, self-esteem, and psychiatric symptoms were gathered at baseline and six months through a combination of structured clinical interviews and self-report surveys. ResultsSEM results at baseline provided support for a model in which self-esteem fully mediated the relationship between role functioning and psychiatric symptoms. The final model explained 20% of the variance in psychiatric symptoms. Analyses at six months post-baseline (time 2) indicate that changes in self-esteem fully mediated the relationship between changes in role functioning and changes in psychiatric symptoms. The final change model explained 23% of the variance in changes in psychiatric symptoms. ConclusionResults provide empirical support for the principles underlying Modified Labeling theory. Implications include the need for interventions that focus on social participation as a means of improving self-esteem, thereby decreasing symptom exacerbation and future relapse for people with SMI.

Children of Depressed Mothers 1 Year After Remission of Maternal Depression: Findings From the STAR*D-Child Study

Maternal major depressive disorder is an established risk factor for child psychopathology. The authors previously reported that 1 year after initiation of treatment for maternal depression, children of mothers whose depression remitted had significantly improved functioning and psychiatric symptoms. This study extends these findings by examining changes in psychiatric symptoms, behavioral problems, and functioning among children of depressed mothers during the first year after the mothers' remission from depression. Children were assessed at baseline and at 3-month intervals with the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version, the Child Behavior Checklist, and the Children's Global Assessment Scale for 1 year after their mothers' remission or for 2 years if the mothers did not remit. The authors compared children of early remitters (0-3 months; N=36), late remitters (3-12 months; N=28), and nonremitters (N=16). During the postremission year, children of early-remitting mothers showed significant improvement on all outcomes. Externalizing behavioral problems decreased in children of early- and late-remitting mothers but increased in children of nonremitting mothers. Psychiatric symptoms decreased significantly only in children of mothers who remitted, and functioning improved only in children of early-remitting mothers. Remission of mothers' depression, regardless of its timing, appears to be related to decreases in problem behaviors and symptoms in their children over the year after remission. The favorable effect of mothers' remission on children's functioning was observed only in children of early-remitting mothers.

Smoking cessation in severe mental illness: what works?

The physical health of people with severe mental illness (SMI) is poor. Smoking-related illnesses are a major contributor to excess mortality and morbidity. An up-to-date review of the evidence for smoking cessation interventions in SMI is needed to inform clinical guidelines. We searched bibliographic databases for relevant studies and independently extracted data. Included studies were randomized controlled trials (RCTs) of smoking cessation or reduction conducted in adult smokers with SMI. Interventions were compared to usual care or placebo. The primary outcome was smoking cessation and secondary outcomes were smoking reduction, change in weight, change in psychiatric symptoms and adverse events. We included eight RCTs of pharmacological and/or psychological interventions. Most cessation interventions showed moderate positive results, some reaching statistical significance. One study compared behavioural support and nicotine replacement therapy (NRT) to usual care and showed a risk ratio (RR) of 2.74 (95% CI 1.10-6.81) for short-term smoking cessation, which was not significant at longer follow-up. We pooled five trials that effectively compared bupropion to placebo giving an RR of 2.77 (95% CI 1.48-5.16), which was comparable to Hughes et al.'s 2009 figures for general population data; RR = 1.69 (95% CI 1.53-1.85). Smoking reduction data were too heterogeneous for meta-analysis, but results were generally positive. Trials suggest few adverse events. All trials recorded psychiatric symptoms and the most significant changes favoured the intervention groups over the control groups. Treating tobacco dependence is effective in patients with SMI. Treatments that work in the general population work for those with severe mental illness and appear approximately equally effective. Treating tobacco dependence in patients with stable psychiatric conditions does not worsen mental state.

Long‐term outcome and post‐treatment effects of psychoanalytic psychotherapy with young adults

The short- and long-term effects of open-ended, long-term psychoanalytic psychotherapy for young adults were investigated. Possible changes during the year and a half follow-up, as well as predictors of change, were explored. Patients aged 18-25 years who accepted the offered psychoanalytic individual or group psychotherapy were included. Patients filled out questionnaires and were interviewed at intake, termination, and follow-up. Alliance data were collected after the second session of psychotherapy proper. The primary outcome measures were the Symptom Checklist-90 and the Inventory of Interpersonal Problems. The Helping Alliance Questionnaire-II was used to measure alliance. Mixed model ANOVAs were used to analyse changeover time and prediction of change in relation to gender, treatment format, treatment duration, and in individual psychotherapy, therapist- and patient-rated alliance. All outcome measures changed significantly from intake to follow-up. None changed significantly during the follow-up period, but there was a tendency towards recurring symptoms and an improvement in one of the object relational measures during the follow-up. The latter was the only outcome measure that did not change significantly during treatment. Lower therapist-rated alliance was predictive of greater change in psychiatric symptoms for patients with high levels of symptoms at intake. The long-term effectiveness of psychoanalytic psychotherapy for young adults was supported. Low therapist-rated alliance implies that the therapists have identified problematic interactions, which might have mobilized their effort to solve the problems. Further research on cases reporting no gain or even deterioration is needed.

Early outcomes and lessons learned from a study of the Building Recovery of Individual Dreams and Goals through Education and Support (BRIDGES) program in Tennessee.

Peer-led education interventions have the potential to provide mental health consumers with the knowledge, skills and support they need to live successful and rewarding self-determined lives. However, few studies have explored whether and how these interventions enhance recovery. This study addresses this knowledge gap by examining changes among 160 participants in the Building Recovery of Individual Dreams and Goals (BRIDGES) education program. BRIDGES is a peer-led 8-week course taught by trained instructors who publicly disclose the fact that they are in recovery from mental illness. Structured interviews assessing recovery outcomes were conducted with participants in the month prior to their receipt of BRIDGES, and immediately after receipt of the intervention. Paired t-tests were conducted to examine changes in psychiatric symptoms, hopefulness, social support, self-advocacy, empowerment, adaptive coping, and recovery pre-receipt and post-receipt of BRIDGES. Post-receipt of BRIDGES, participants reported significantly fewer psychiatric symptoms, decreased use of maladaptive coping behaviors, and increased feelings of hopefulness, self-advocacy, empowerment, and recovery. These promising early results from our ongoing study of BRIDGES suggest that peer-led education interventions are a valuable resource. Additional research is needed to better understand the effectiveness of these interventions, including potential long-term post-program participation benefits.

Predictors of Abstinence and Changes in Psychiatric Symptoms in a Pooled Sample of Smokers With Schizophrenia Receiving Combination Pharmacotherapy and Behavioral Therapy for Smoking Cessation

Predictors of Abstinence and Changes in Psychiatric Symptoms in a Pooled Sample of Smokers With Schizophrenia Receiving Combination Pharmacotherapy and Behavioral Therapy for Smoking Cessation

Inpatient Treatment for Adult Survivors of Childhood Sexual Abuse: A Preliminary Outcome Study

The objective of this study was to examine the changes in psychiatric symptoms and interpersonal problems in 34 adults with a history of childhood sexual abuse and posttraumatic stress disorder who attended a 3-month inpatient treatment program. Levels of posttraumatic, depressive, and general psychiatric symptoms and interpersonal problems were assessed at pre-care evaluation, admission, discharge, and 1-year follow-up using the Impact of Event Scale, the Beck Depression Inventory, the Symptom Check List 90 Revised, and the Inventory of Interpersonal Problems. Work status was assessed at admission and at follow-up. Significant improvements were seen during treatment on the global scores of all instruments except the Beck Depression Inventory. At follow-up, patients had kept their gains on symptom measures and experienced further progress regarding interpersonal problems. At discharge, 3 of the previously 32 unemployed patients were able to return to work. Patients with comorbid somatization disorder tended to have higher levels of distress and less favorable treatment response. Future studies should include pre- and posttreatment assessment of dissociation to evaluate its association with outcome.

Capturing the Ebb and Flow of Psychiatric Symptoms With Dynamical Systems Models

Psychiatric symptoms play a crucial role in psychology and psychiatry. However, little is known about how dimensions of symptoms--other than symptom level--relate to psychiatric outcomes. Until recently, methods for measuring dynamic aspects of symptoms have not been available to clinicians or researchers. The authors sought to test whether systematic patterns of change in psychiatric symptoms can be recovered across weekly assessments of individuals at high risk for violence. A secondary objective was to explore whether dynamic features of symptoms (specifically, oscillation speed and dysregulation) are concurrently associated with violence, an important indicator of functional impairment for these individuals. Participants (N=132) were drawn from a sample of patients evaluated at the emergency room of an urban psychiatric hospital. Patients actuarially classified as being at high risk for violence were eligible for participation in the study. Participants and collateral informants were interviewed weekly for 26 weeks following an acute psychiatric evaluation. Psychiatric symptoms were assessed using the Brief Symptom Inventory. Measures of symptom fluctuation and regulation were derived using dynamical systems models. Involvement in violence was assessed using self, informant, and official reports. Individuals' symptom dynamics were recovered by a linear oscillator model that described how quickly symptoms oscillated and whether symptoms were amplifying or moving back toward equilibrium across time. Patterns of rapid symptom fluctuation and symptom amplification were concurrently associated with violence. Psychiatric researchers and clinicians have long been interested in adopting more dynamic approaches to understanding symptom change. This study is the first to demonstrate that systematic fluctuations in symptom patterns may be captured by dynamic models. Moreover, the concurrent association between symptom dynamics and violence suggests avenues for future research to test how features of symptom fluctuation could affect behavior.

P03-52 Prediction of demographic factors on the outcome of short- and long-term psychotherapy

Background:Demographic factors have been shown to predict the outcome of short-term psychotherapy in the treatment of depressive and anxiety disorders. So far, however, information on the prediction for long- term therapy is missing. to be able to choose an optimal psychotherapy length for the patient, it is essential to know, which demographic factors predict different outcome in short- and long-term therapy.Aim:To compare the prediction of demographic factors on changes in psychiatric symptoms in short- and long-term psychotherapy.Methods:In the Helsinki Psychotherapy Study, 326 psychiatric outpatients, aged 20-46 years, and suffering from depressive or anxiety disorders, were randomly assigned to short-term therapy (short-term psychodynamic psychotherapy or solution-focused therapy combined) or long-term psychodynamic psychotherapy. the demographic factors (i.e. age, gender, education, income, and living arrangement) were assessed at baseline by a questionnaire. Psychiatric symptoms were assessed with the Symptom Check List, Global Severity Index (SCL-90-GSI) at baseline and 7 times during a 3-year follow-up.Results:Demographic factors were found to predict symptom development during follow-up irrespective of baseline symptom level. Female gender, being aged 25 or more, living with a spouse/partner, high education, and medium level personal income predicted benefiting sufficiently from short-term therapy, whereas being aged under 25, medium education, and living with other(s) than a partner or child(ren) predicted the need of long-term therapy.Conclusions:Demographic factors may be a useful tool in the selection of patients for short- and long term therapy.