Day-clinic Treatment Research Articles

Motor and non-motor improvements following short-term multidisciplinary day-clinic care in Parkinson´s disease

BackgroundInpatient as well as outpatient care does often not meet PD-patients’ individual needs.IntroductionDay-clinic concepts encompassing a multidisciplinary team as well as therapy adjustments accompanying everyday demands aim at filling this gap.MethodsThis is a retrospective study on short-term effects of a 3 week multidisciplinary rehabilitation program in patients with Parkinson´s disease (PD) embedded in a specialized movement disorder day-clinic. We analyzed short-term outcome of motor and non-motor symptoms (NMS) in 143 PD-patients (mean age 65.3 ± 11.9 years; Hoehn-and-Yahr-score 2.6 ± 0.7) after 3 weeks with 7.4 ± 1.8 active days of interdisciplinary day-care treatment. Participants attended the day-clinic in groups of five patients at a time. Improvements were evaluated by comparison of standardized physical therapy assessments, disease specific scores for motor symptoms (MDS–UPDRS III), mood (BDI), quality of life (PDQ39, SF36), sleep (PDSS, ESS), impulsiveness (QUIP), apathy (SAS), cognition (MMST), as well as change in medication before and directly after the intervention.ResultsMDS–UPDRS motor score improved significantly by 22.9 ± 21.5% (p < 0.001) and was accompanied by a significant reduction of imbalance, immobility, and weakness ranging between 6% and 17% in standardized physical therapy tests. In addition, all disease-specific non-motor scales improved significantly.ConclusionsA multidisciplinary day-clinic approach can support benefit on motor, non-motor symptoms and QoL in PD-patients. Given the increase in PD incidence and prevalence as well as the significant treatment effects shown here, more day-clinic treatment opportunities ought to be implemented to improve PD treatment adapted to everyday challenges while still reducing costs to the health care system.

Outcome Quality of Inpatient and Day-Clinic Treatment in Child and Adolescent Psychiatry—A Naturalistic Study

Background: Child and adolescent psychiatry has only recently been established as a separate specialty and is practiced in different settings. The epidemiology of psychological problems in childhood is high and varied, thus qualitative work is essential. Assessment of outcome as part of quality management is central to assure the service of psychiatric care to be effective. Method: Over a three-year period consecutively admitted patients from inpatient and day-clinic treatment were prospectively evaluated. A total of 200 from 442 patients (m = 80, f = 120; age 15.1 ± 2.8 y) agreed to participate. Patients, caregivers, and therapists answered a range of questionnaires to provide a multi-personnel rating. Questionnaires used for outcome assessment were Child Behavior Checklist (CBCL) and Youth-Self-Report (YSR) (at admission, discharge, and 6 weeks after discharge) and the problem score of the Inventory of Quality of Life for children (ILK), treatment satisfaction, and process quality by the Questionnaire for Treatment Satisfaction (FBB, at discharge) and as real-life outcome control assessment of quality of life (ILK) was added (admission, discharge, and 6 wks after discharge). Results: There was a significant reduction in psychopathologicalsymptoms (CBCL, YSR) and in the problem score. Furthermore, there was a significant increase in quality of life. QoL score and YSR/CBCL scores returned to normal levels. Treatment satisfaction was high and so was satisfaction with process quality. Factors significantly influencing outcome were severity of disease and the relationship to the therapist. No differences were found for gender and setting. Conclusion: The quality management analysis revealed significant improvements of symptom load, a significant increase in QoL and a high treatment satisfaction. Furthermore, process quality was scored highly by parents and therapists.

Helping Families of Infants With Persistent Crying and Sleep Problems in a Day-Clinic.

Excessive crying and sleep problems affect up to 30% of infants and often coexist. Although usually benign and self-limiting, persistent crying, and sleep problems exceeding 6 months of age need attention as they may impair the mental health of the infant and its family. The source and the impact of these persistent regulatory problems is often not restricted to the infant, but extends to the parents and the parent–infant relationship. Clinical practice needs interdisciplinary and multi-method interventions focusing beyond regulatory problems of the infant but also on parental self-regulation and parent's co-regulatory responses toward the infant. Treating clinicians may encounter limitations of home-visits, outpatient, and pediatric residential settings when working with families in distress. We describe an infant mental health day-clinic treatment, drawing attention to this viable future direction. It offers a therapeutic climate based on forming a triangle of co-regulation between clinician, parent and infant to first help the parent and the infant settle down. This stress reduction restores parent–infant connectedness and parental learning and reflecting capacity. Clinicians then use established therapeutic modalities to support parental self- and co-regulatory skills which is important for the development of self-regulation in the infant. Experience with this treatment program suggests that a day-clinic setting facilitates interdisciplinary and integrative multi-method intervention, infant and parental stress reduction and integration of parental self- and co-regulatory skills in daily family life, improving overall outcomes. This perspective warrants further investigation.

Long-Term Outcomes of a Multimodal Day-Clinic Treatment for Chronic Pain under the Conditions of Routine Care.

Chronic pain has high prevalence rates and is one of the top causes of years lived with disability. The aim of the present study was to evaluate the long-term effects of a multimodal day-clinic treatment for chronic pain. The sample included 183 chronic pain patients (114 females and 69 males; 53.3 ± 9.8 years) who participated in a four-week multimodal day-clinic treatment for chronic pain. The patients' average current pain intensity (NRS), sensory and affective pain (Pain Perception Scale), and depression and anxiety (HADS) were assessed at pre- and posttreatment, as well as at three follow-ups (one month, six months, and twelve months after completion of the treatment). Multilevel models for discontinuous change were performed to evaluate the change of the outcome variables. Improvements from pretreatment to posttreatment and from pretreatment to all follow-ups emerged for pain intensity (NRS; 0.54 ≤ d ≤ 0.74), affective pain (Pain Perception Scale; 0.24 ≤ d ≤ 0.47), depression (HADS; 0.38 ≤ d ≤ 0.53), and anxiety (HADS; 0.26 ≤ d ≤ 0.43) (all p < 0.05). Sensory pain as assessed with the Pain Perception Scale did not show any significant change. Patients suffering from chronic pain benefited from the multimodal pain treatment up to twelve months after completion of the treatment.

An effective treatment concept for patients with substance use disorders

At the Department of Psychiatry and Psychotherapy of the University of Munich a "day clinic for substance use disorders" was opened in 2014. A multimodal treatment concept for patients with addictions was developed. Employees of the clinic performed a first scientific study to assess the effects of treatment approaches on the course of the disease. Data were collected over two years to evaluate the treatment concept. I. a., the severity of depressive symptoms, anxiety symptoms, craving and several aspects of the subjective quality of life were documented. In addition, participants were examined about their contentment with the day-clinic treatment. Symptoms of depression, anxiety and craving were significantly reduced during the day-clinic treatment. The subjective quality of life increased almost in all areas. In order to stabilize patients with addictions, a multimodal treatment concept can be applied effectively.

Investigating biases of attention and memory for alcohol-related and negative words in alcohol-dependents with and without major depression after day-clinic treatment

This study aimed to investigate attentional and memory biases in alcohol-dependents with and without major depression compared to healthy controls. We assumed that both groups of alcohol-dependents would show attentional and memory biases for alcohol-related words. For the alcohol-dependents with depression, we additionally expected both types of biases for negative words. Alcohol-dependents without co-morbidity (Alc) and alcohol-dependents with major depression (D-Alc) as well as control participants with a moderate consumption of alcohol (Con) completed an alcohol Stroop task and a directed forgetting paradigm using word stimuli from three categories: neutral, negative, and alcohol-related. Stroop effects showed that not only alcohol-dependents but also control participants were more distracted by alcohol-related than by negative words. In the directed forgetting procedure, all participants showed a significant effect for each word-category, including alcohol-related and negative words. The D-Alc-group memorized more alcohol-related than negative to-be-remembered words. The results do not corroborate the hypothesis of more pronounced attentional and memory biases in alcohol-dependents. However, in alcohol-dependents with depression a memory bias for alcohol-related material was found, suggesting that this group may be more pre-occupied with alcohol than patients without such co-morbidity.

Do personality disorders predict negative treatment outcome in obsessive–compulsive disorders? A prospective 6-month follow-up study

Background. – Comorbid personality disorders (PDs) are discussed as risk factors for a negative treatment outcome in obsessive–compulsive disorder (OCD). However, studies published so far have produced conflicting results. The present study examined whether PDs affect treatment outcome in patients with OCD. Method. – The treatment sample consisted of 55 patients with OCD who were consecutively referred to a Behaviour Therapy Unit for an in-patient or day-clinic treatment. Treatment consisted of an individualised and multimodal cognitive behaviour therapy (CBT, with or without antidepressive medication). Measurements were taken prior and after treatment and 6-month after admission. Results. – A large percentage of patients benefited from treatment irrespective of the presence of a PD and were able to maintain their improvement at follow-up. Duration of treatment was not prolonged in OCD patients with concomitant Axis II disorders. However, some specific personality traits (schizotypal, passive–aggressive) were baseline determinants for later treatment failure at trend level. Conclusions. – Results are encouraging for therapists working with patients co-diagnosed with Axis II disorders since these patients are not necessarily non-responders. The results stress the importance of a specifically tailored treatment approach based on an individual case formulation in OCD patients with complex symptomatology and comorbid Axis II disorders.

Replacing the Last Week of a Motivational Inpatient Alcohol Withdrawal Programme by a Day-Clinic Setting

The impact on the motivation to treatment of a qualified alcohol withdrawal programme was evaluated in a pre/post setting. Over a period of 2 years we compared the results of replacing the last week of an inpatient setting by day-clinic treatment. In the first year, 202 patients were treated in a 3-week inpatient setting, whereas in the second year, 149 patients out of 212 (70.3%) changed into day-care for the third week. The total treatment period was nearly equal in both years (16.2–17.4 days) and the average costs of detoxication were reduced by 8%. The amount of irregular discharges (21.7 vs. 23.6%) was almost unchanged. As a severe disadvantage the overall rate of patients who agreed to enter a succeeding stringent long-term treatment regressed significantly from 45.0 to 34.4% (p < 0.05).

Anxiety as a concomitant symptom of depression in the elderly

Anxiety is a symptom frequently encountered in elderly depressed patients. It is supposed to have an unfavourable prognostic impact. We studied the frequency of psychic anxiety and its relationship to demographic, social and clinical variables in a group of 54 elderly depressed patients admitted to a gerontopsychiatric day-clinic. Severity of depression, cognitive performance, functional level, social situation and life satisfaction were studied by means of standardized instruments. In about half of the patients studied, we found significant psychic anxiety. Compared to the other depressed patients, patients with anxiety suffered more frequently from cognitive impairment and were more dissatisfied with the acceptance of their disease by other persons. They more frequently lived together with other persons in one household. When leaving psychic anxiety out of consideration as a depressive symptom, the severity of depression was not different in patients with and without anxiety. Anxious patients were equally responsive to day-clinic treatment as non-anxious patients. However, duration of treatment was considerably increased. Thus, elderly depressed patients with anxiety show particular psychosocial and clinical features and require special attention in diagnostics and treatment.