Global Severity Index Scores Research Articles

Quality of Life and Psychological Distress of Adult Recipients After Living Donor Liver Transplantation

This longitudinal prospective study evaluated health-related quality of life (HRQoL) and psychological distress among recipients after right-lobe adult–adult living donor liver transplantation (LDLT). We measured HRQoL among 81 consecutive recipients using the Chinese version of the Medical Outcomes Study Short Form-36 (SF-36). Psychological symptoms were measured using the Symptom Checklist-90-Revised (SCL-90-R). Clinical data were collected from Chinese Liver Transplant Registry records. Sixty-two recipients completed follow-up assessments at 6, 12, 24, and 36 months posttransplantation. SF-36 domain scores were lowest at 6 months, especially for role-physical, bodily pain, vitality, social functioning, role-emotional and mental component summary scale scores. They improved dramatically in the first year posttransplantation. None of the SF-36 domain scores differed significantly between 12 and 24 months. No SCL-90-R dimension score differed significantly among the four assessments (P > .05). Mental component summary scale scores significantly correlated with all four SCL-90-R global severity index scores (P < .05). HRQoL improved significantly in adult recipients in the first year after LDLT, but not thereafter. Patients recovered psychological well-being quickly after transplantation; this factor had an important influence on the HRQoL of LDLT recipients.

Single administration of lesion‐limited high‐dose (TURBO) ultraviolet B using the excimer laser: clinical clearing in association with apoptosis of epidermal and dermal T cell subsets in psoriasis

Development of effective therapy for psoriasis is confounded by numerous factors contributing to disease pathogenesis, including pathogenic immunocytes which appear to drive epidermal keratinocyte hyperproliferation. Our objective was to study clinical and biomarker effects of a single dose of TURBO laser UVB (308 nm) applied directly to psoriatic plaques. Eighteen patients with chronic plaque psoriasis received a single dose of 10 minimal erythema dose (MED) UVB and were followed for 8 weeks. Keratome and punch biopsies were assessed for T cell depletion and apoptosis following a single 308-nm dose of UVB. Patients demonstrated clinical improvement as indicated by decreased global Psoriasis Area and Severity Index scores and reduced numbers of pathogenic memory/effector T cells infiltrating lesional epidermis and dermis. Consistent with apoptosis induction, caspase activation increased in lesional T cells after treatment. We conclude that a single 10 MED dose of TURBO UVB is effective at reducing the severity and extent of psoriatic lesions. We hypothesize that the reason a single treatment is sufficient to clear a psoriatic plaque is that the 10 MED dose is able to deliver sufficient photons to a microanatomic area of the lesion where susceptible pathogenic T cell mechanisms are operative.

Emotional Intelligence and Personality as Predictors of Psychological Well-Being

Research studies have reported elevated rates of psychological distress (e.g., depression) in practicing lawyers yet little research has examined predictors of such problems in law students. Specific personality traits have been shown to be predictors of a range of psychological problems. We administered a battery of tests to a cohort of 1st-year law students ( n = 150) and measured the Big Five personality traits and emotional intelligence (EI) to examine their relationships to psychological well-being as indicated by coping styles, satisfaction with life, performance-based self-esteem (PBSE), Global Severity Index (GSI) scores from the Brief Symptom Inventory (BSI), depression, and alcohol use. We found that whereas EI was significantly related to three of the five well-being variables, the Big Five personality factor of neuroticism was found to be a stronger predictor of well-being. The findings suggest that EI does not account for additional variance in well-being over personality.

Mental health and quality of life in patients with chronic otitis media

The present study focused on the comparison of mental health and quality of life (QoL) between chronic otitis media (COM) patients and the hearing population. The patients with chronic otitis media and healthy control group were enrolled in the study. The duration and severity of the auditory impairment were recorded. In addition to hearing loss (HL), the findings of each patient's other ear disorders (ear discharge and tinnitus) were also recorded. In both the groups, psychological symptom profile and health-related QoL were evaluated and compared using a sociodemographic questionnaire, the Symptom Check List 90-Revised Form (SCL-90-R), and the Short Form-36 (SF-36). According to SCL-90-R, somatization (p < 0.001), interpersonal sensitivity (p < 0.001), depression (p < 0.001), phobic anxiety (p < 0.001), and other subscores, and also global severity index score (p < 0.001) were significantly high in patient group when compared to the control group. The patients with COM reported significantly lower levels of QoL in terms of physical role difficulty (p < 0.001), general health perception (p < 0.004), social functioning (p < 0.001), and mental health (p < 0.017) than those of control subjects. Our results indicated that COM patients with mild or moderate HL have poorer life quality and higher psychological problems. Psychological well being should be also considered in assessment of COM patients in addition to the clinical evaluation and audiological tests.

Pilot Evaluation of the Impact of Structured Child-Centered Interventions on Psychiatric Symptom Profile of Parents with Serious Somatic Illness: Struggle for Life Trial

This is a trial of cancer patients who are seriously somatically ill and of how their distress affects their spouse or children. In the pilot phase the authors examined whether there are changes in psychiatric symptom profile of seriously somatically ill and healthy parents between assessments concerning a situation before the onset of parental illness, in current situation before intervention and 4 months after the intervention. The study is a family cluster, randomized, controlled treatment trial for parents and children in families with a parent who has a serious somatic illness. Global Severity Index (GSI) and psychiatric symptom profile of parents was assessed with the Symptoms Checklist-90 for adults. At pilot evaluation phase of the Struggle for Life trial, a total of 19 families (16 patients, 15 spouses) participated in the baseline assessment conducted before intervention, and 10 families (seven patients, seven spouses) also at the 4-month follow-up after the intervention. The interventions used in this study were the short Let's Talk about Children including two meetings with parents and more intensive Family Talk Intervention consisting of six to eight meetings with parents, children, and whole family. At the 4-month follow-up the GSI score of the patients and spouses was significantly decreased compared to the baseline score. At the baseline the GSI score of the patients was at the same level as that of the psychiatric outpatient sample, whereas at the 4-month follow-up it was at the same level as in the general population. This study lends support to previous studies that recommend that treatment practice should include structured interventions with parents concerning parenting and the wellbeing of children.

Impact of psychological problems in chemical warfare survivors with severe ophthalmologic complication, a cross sectional study

BackgroundSulfur mustard (SM) has been used as a chemical warfare agent since the early twentieth century. Despite the large number of studies that have investigated SM induced ocular injuries, few of those studies have also focused on the psychological health status of victims. This study has evaluated the most prominent influences on the psychological health status of patients with severe SM induced ocular injuries.MethodsThis descriptive study was conducted on 149 Iranian war veterans with severe SM induced eye injuries. The psychological health status of all patients was assessed using the Iranian standardized Symptom Check List 90-Revised (SCL90-R) questionnaire. The results of patients' Global Severity Index (GSI) were compared with the optimal cut-off point of 0.4 that has previously been calculated for GSI in Iranian community. The Mann-Whitney U test, T tests and effect sizes (using Cohen's d) were employed as statistical methods. Data were analyzed using SPSS software.ResultsThe mean age of patients was 44.86 (SD = 8.7) and mean duration of disease was 21.58 (SD = 1.20) years. Rate of exposure was once in 99 (66.4%) cases. The mean GSI (1.46) of the study group was higher compared to standardized cut off point (0.4) of the Iranian community. The results of this study showed that the mean of total GSI score was higher in participants with lower educational levels (effect size = 0.507), unemployment (effect size = 0.464) and having more than 3 children (effect size = 0.62). Among the participants, 87 (58.4%) cases had a positive psychological history for hospitalization or receiving outpatient cares previously and 62 (41.6%) cases had a negative psychological history. In addition, the mean of GSI in participants with negative psychological history was lower than those with positive psychological history (Mean Change Difference = -0.621 with SD = 0.120). There was a significant difference between positive and negative psychological history with respect to GSI (P < 0.001).ConclusionThe study showed that severe ophthalmologic complications in chemical survivors are accompanied with destructive effects on psychological health status. Appropriate management may improve psychological health status in these patients.

Can sharing experiences in groups reduce the burden of living with diabetes, regardless of glycaemic control?

To test whether patients with Type 1 diabetes would join support groups and benefit by improving psychosocial functioning, regardless of their HbA1c levels. A pre-post test with follow-up after 6 and 12 months was conducted as a concurrent mixed-method study. The convenience sample included patients with Type 1 diabetes aged ≥21 years, having been diagnosed ≥1 year earlier. Primary outcome was diabetes-related distress (using the Problem Areas in Diabetes scale). Secondary outcomes were psychological distress and depressive symptoms (Symptom Check List -90-R/Global Severity Index and depression subscale), well-being (World Health Organization 5) and HbA1c . Equal numbers of patients with HbA1c above and below 64 mmol/mol (8%) joined the support groups (n = 54). Focus group interviews revealed that major benefits were feeling less alone and being intuitively understood among peers. The patients perceived the support groups as a safe environment for sharing experiences. Problem Areas in Diabetes, Global Severity Index and depression subscale scores were significantly reduced post-intervention and maintained at 1-year follow-up. Well-being increased insignificantly. HbA1c was unchanged. Support groups are able to reduce diabetes-related and psychological distress 1 year after the intervention for patients with both good and poor glycaemic control displaying high levels of distress. Although patients with severely high levels of diabetes-related distress might need more extensive therapeutic interventions to further reduce their level of distress. Further, interventions that target specific self-management problems are needed for patients with poor glycaemic control to help them accomplish lower levels of HbA1c. Moreover, healthcare providers must be aware that patients with good glycaemic control might have an unacknowledged psychosocial burden of living with the illness.

Preventing melasma recurrence: prescribing a maintenance regimen with an effective triple combination cream based on long‐standing clinical severity

The relapsing nature of melasma emphasizes the need to maintain efficacy achieved after acute treatment. To compare clinical efficacy and safety of two 6-month Triple Combination (TC; containing fluocinolone acetonide, hydroquinone and tretinoin) maintenance regimens in subjects with moderate to severe melasma, after daily treatment up to 8 weeks. This randomized, investigator-blinded, controlled study had a maintenance phase of 6 months. Sixteen centres in Brazil and Mexico enrolled 242 subjects 18 years or older attaining no or mild melasma after 8 weeks of daily TC applications. Subjects were randomized to receive TC in a twice weekly or tapering regimen [3/week (1st month), 2/week (2nd month), 1/week (4th month)]. Efficacy and safety measurements included median time to relapse and relapse-free rate, Global Severity Score, Melasma Area and Severity Index score (MASI), subject's assessment, quality of life questionnaire (MelasQol), and adverse events. The majority (78.8%) had no or mild melasma (GSS ≤ 1) at week 8 and entered maintenance phase. After 6 months, 53% of patients remained relapse-free with improved quality of life, and time to relapse was similar between groups (about 190 days). Melasma severity at study entry, not maintenance baseline, influenced relapse rate. The twice weekly regimen tended to show better effectiveness in postponing relapse in severe melasma. Both regimens were safe. After resolution of melasma with TC, maintenance therapy over 6 months was successful in preventing relapse in over half of the patients who entered maintenance phase. Prescribing medicines should be adapted to patients based on melasma severity.

Influence of night shift work on psychologic state and quality of life in health workers

Objective: This study aimed to assess the symptoms of psychopathology caused by the shift-work and to evaluate their impact on the quality of life. Method: Forty-two nurses working at daytime and 45 nurses working at the night shift were evaluated with Symptom Checklist-90-R (SCL-90-R) and Short Form 36 (SF-36) for assessing general psychiatric symptoms and quality of life. Results: Shift-work nurses reported significantly higher somatization, obsessive-compulsive, interpersonal sensitivity, anxiety, paranoid ideation and global severity index scores than daytime nurses. Significant differences were not found in the depression, hostility, phobic anxiety and psychoticism scores. Shift-work nurses also reported significantly worse scores on pain and physical function compared with daytime nurses. Conclusion: In our study, shift-work was shown to be a potential risk factor for increased psychiatric morbidity and low quality of life among nurses. Therefore, adjusting the work schedule with the potential problems of the workers may improve their life quality.

Peritraumatic Heart Rate and Posttraumatic Stress Disorder in Patients With Severe Burns

Previous studies have suggested a link between heart rate (HR) following trauma and the development of posttraumatic stress disorder (PTSD). This study expands on previous work by evaluating HR in burn patients followed longitudinally for symptoms of acute stress disorder (ASD) and PTSD. Data were collected from consecutive patients admitted to the Johns Hopkins Burn Center, Baltimore, Maryland, between 1997 and 2002. Patients completed the Stanford Acute Stress Reaction Questionnaire (n = 157) to assess symptoms of ASD. The Davidson Trauma Scale was completed at 1 (n = 145), 6 (n = 106), 12 (n = 94), and 24 (n = 66) months postdischarge to assess symptoms of PTSD. Heart rate in the ambulance, emergency room, and burn unit were obtained by retrospective medical chart review. Pearson correlations revealed a significant relationship between HR in the ambulance (r = 0.32, P = .016) and burn unit (r = 0.30, P = .001) and ASD scores at baseline. Heart rate in the ambulance was related to PTSD avoidance cluster scores at 1, 6, 12, and 24 months. In women, HR in the ambulance was correlated with PTSD scores at 6 (r = 0.65, P = .005) and 12 (r = 0.78, P = .005) months. When covariates (gender, β-blockers, Brief Symptom Inventory Global Severity Index score) were included in multivariate linear regression analyses, ambulance HR was associated with ASD and PTSD scores at baseline and 1 month, and the interaction of ambulance HR and gender was associated with PTSD scores at 6 and 12 months. Multivariate logistic regression results were similar at baseline and 12 months, which included an HR association yet no interaction at 6 months and a marginal interaction at 1 month. While peritraumatic HR is most robustly associated with PTSD symptom severity, HR on admission to burn unit also predicts the development of ASD. Gender and avoidance symptoms appear particularly salient in this relationship, and these factors may aid in the identification of subgroups for which HR serves as a biomarker for PTSD. Future work may identify endophenotypic measures of increased risk for PTSD, targeting subgroups for early intervention.

Predictors of psychiatric symptom scores in a sample of Turkish high school students

Most mental health problems start in adolescence and early adulthood. According to the literature, one out of five children and adolescents suffers at least one mental health problem. In this cross-sectional study, the distribution of psychiatric symptom scores among 728 Turkish high school students in grades 9, 10, and 11 was examined and associated with the students' gender, type of school, and grade level, as well as parental attitudes. The Brief Symptom Inventory and The Global Severity Index were used in this study. The latter is a global index of the former, and assesses indications of psychopathological disturbance. Girls score significantly higher than boys on all subscales of the Inventory, and specifically the Index. The highest Global Severity Index scores were obtained from the students who were attending vocational high schools, those who were in 11th grade, and those who indicated indifferent parental attitudes. This study revealed the need for a closer investigation of those students who are at severe risk of mental health problems.

Longitudinal relationship between psychological distress and multiple substance use: results from a three-year multisite natural-history study of rural stimulant users.

Substance use is associated with poor mental health, but little is known regarding how use of multiple substances is associated with mental health, particularly longitudinally, in community studies. This article examines this issue in a large (N = 710), natural-history study of rural stimulant (cocaine and/or methamphetamine) users in three states. Respondent-driven sampling recruited recent (past-30-day) stimulant users in three counties each in Arkansas, Kentucky, and Ohio. Participants were interviewed every 6 months for 3 years. Mental health was measured by the Brief Symptom Inventory, and prior 6 months' substance use was measured for 17 possible substances. Data analysis used generalized estimating equations for longitudinal data with the Global Severity Index of the Brief Symptom Inventory as the dependent variable at each interview and substance use as predictor variables measured by number of substances used in the past 6 months and, separately, the 17 individual substances, adjusting for use of substance-use treatment, demographics, and recruitment site. On average, both Global Severity Index score and use of many substances declined over the course of study. Global Severity Index score was significantly associated with (a) greater number of substances used in the past 6 months (p < .0001) and (b) use of crack cocaine, methamphetamine, and nonprescription use of prescription painkillers and tranquilizers. Multiple and specific substances appear to incrementally increase psychological distress. Users of cocaine and methamphetamine are present in rural areas; these associations with poor psychological health raise concerns regarding availability of local treatment services for individuals with mental-health problems, as well as substance abuse.

Psychiatric distress, risk behavior, and treatment enrollment among syringe exchange participants

The present study evaluated psychiatric distress as a predictor of treatment enrollment in out-of-treatment injection opioid users newly registered at the Baltimore Needle Exchange Program (BNEP). Study participants ( n = 281) completed the Addiction Severity Index (ASI), the Risk Assessment Battery (RAB), and the Symptom Checklist-90 (SCL-90-R), and were randomly assigned to one of three different conditions for 4 months that evaluated referral strategies designed to promote treatment interest and enrollment. The Global Severity Index (GSI) of the SCL-90 was used as a measure of psychiatric distress. A logistic regression showed that higher GSI scores predicted more treatment enrollment (Adjusted OR = 2.15, CI = 1.10–4.23, p < 0.05), after controlling for study condition, demographic variables, syringe exchange site, and severity of drug use. The results suggest that the data from the assessment of psychiatric distress in syringe exchange settings can be used to support motivational strategies for encouraging syringe exchangers to seek substance abuse treatment.

The Adjective Check List as an outcome measure: Assessment of personality change in psychotherapy

To investigate the value of the Adjective Check List (ACL) as a psychotherapy outcome measure, the ACL and Symptom Checklist-90-Revised (SCL-90-R) were administered at four times (before therapy, immediately after therapy, and at 6-month and 1-year follow-ups) to 38 patients in brief dynamic psychotherapy. High correlations between selected ACL scales and SCL-90-R Global Severity Index scores (GSI) were found. GSI change from before to after therapy correlated with change on the ACL scales. Changes from before to after therapy were detected for ACL scales at both the mean group and the individual levels. Because the ACL provides valuable information on personality dimensions as well as concurrent levels of distress, it is a particularly promising psychotherapy outcome measure.

Psychosocial distress and somatic symptoms in community subjects with irritable bowel syndrome: a psychological component is the rule.

Psychosocial factors may drive people with irritable bowel syndrome (IBS) to seek health care, but whether psychological factors are causally linked to IBS is controversial. One hypothesis is that IBS is a heterogeneous syndrome comprising two distinct conditions, one psychological and the other biological. However, it is unclear how many people with IBS in the community have little somatization and minimal psychosocial distress. The aim of our study was to estimate the proportion of people with IBS in a representative US community, who have low levels of somatic and psychological symptoms. The cohort comprised subjects from three randomly selected population studies from Olmsted County, Minnesota. All of them filled out a validated gastrointestinal (GI) symptom questionnaire, the Symptom Checklist-90-R (SCL-90-R), and the Somatic Symptom Checklist (SSC) comprising 11 somatic complaint items. Logistic regression models were used to evaluate the associations between somatic symptoms/psychosocial factors and IBS, adjusting for age and gender. Of the 501 eligible subjects, 461 (92%) provided complete data (mean age=56 years, 49% female). IBS (Rome II criteria) was associated with both higher SSC and Global Severity Index (GSI of SCL-90-R) scores. Among subjects with high (75th percentile) SSC scores, 43% reported IBS vs. 10% of those with low (<25th percentile) SSC scores. Among those with high (60) GSI scores, 23% reported IBS vs. 6% with low (<40) GSI scores. Specifically, none of the IBS subjects had both low SSC and low GSI scores. Psychological factors and somatization are strongly associated with IBS in the community. However, IBS may not be related to low psychological distress and/or somatization.

Cross-Ethnic Measurement Invariance of the Brief Symptom Inventory for Individuals with Mental Illness

The purpose of this study was to test the measurement invariance of the Brief Symptom Inventory's (BSI) secondary factor model across African, white, and Latino Americans using multiple-group confirmatory factor analyses. This study provides an examination of the BSI's validity for use in mental health service research for people with severe and persistent mental illness (SPMI). The sample consisted of 1,166 individuals receiving treatment for SPMI in a publicly funded mental health system in Los Angeles, California. The results showed that the secondary factor model fit the data very well. The findings suggest that the BSI can be used with African, white, and Latino Americans diagnosed with SPMI to assess their psychological distress and that it can be useful in comparing systematic group differences in observed means and covariance matrices across the three ethnic groups. It is recommended that the nine subscale scores and the Global Severity Index score of the BSI be used in practice and research with African, white, and Latino Americans with SPMI. KEY WORDS: Brief Symptom Inventory; confirmatory factor analysis; ethnic disparities; measurement invariance; severe and persistent mental illness ********** Valid measurement tools are critical for assessing a wide range of phenomena in mental health. Measurement instruments are used in clinical practice and in research to identify patients in a general population, to assess psychological symptoms, and to evaluate individual changes in symptoms resulting from treatment. A critical issue in the use of psychological measures is the possible variance resulting from differences across ethnic groups. The surgeon general's report (U.S. Department of Health and Human Services, 2001) emphasized that conceptual and scale equivalence, also called measurement invariance, is important to mental health services and research. For example, community-based psychosocial treatment programs for people with severe and persistent mental illness (SPMI) are limited in their ability to demonstrate program effectiveness in the case of ethnic minority groups because of the lack of standardized treatment outcome measures that are equivalent across different ethnic groups (National Institute of Mental Health, 2003). Plausible cultural differences can prohibit measures of psychological symptoms from being equivalent across ethnic groups, which results in the lack of validity in making clinical assessments and evaluating treatment outcomes. Recent discussions about ethnic disparities in the access, utilization, and outcome of health and mental health services (Ramirez, Ford, Stewart, & Teresi, 2005; Snowden, 2003) have highlighted the need for assessment tools that are valid across ethnic groups so that these disparities can be adequately understood and ameliorated. Thus, it is imperative to test whether symptom measures of interest hold measurement invariance across ethnic groups. The Brief Symptom Inventory (BSI) is a self-report mental health symptom scale (Derogatis & Melisaratos, 1983). It is a 53-item version of Symptom Checklist-90 (SCL-90-R) (Derogatis, 1992). According to the BSI manual (Derogatis, 1993), it is designed to assess general psychiatric distress using nine subscales. A Global Severity Index (GSI) can be derived, which is the average score of all 53 items. The BSI has been used with a wide range of adult populations. For example, an Ovid Medline search yielded more than 260 publications since 2000 that used the BSI, and PsycINFO listed more than 1,700 publications since 2000 that have used the BSI. The BSI is also widely used in mental health research on people with SPMI as a psychiatric symptom measure. For example, the BSI has been used in studies of comparative culture (Coelho, Strauss, & Jenkins, 1998), pharmacology (Salokangas et al., 1996), quality of life (Ritsner, 2003), family issues (Jenkins & Schumacher, 1999), involuntary outpatients (Swartz, Swanson, Wagner, Burns, & Hiday, 2001), program effectiveness (Kingsep, Nathan, & Castle, 2003), service systems (Mares, Young, McGuire, & Rosenheck, 2002), and measurement studies (Preston & Harrison, 2003). …

Alexithymia and Outcome in Psychotherapy

Background: About 25% of all patients seeking psychotherapeutic treatment are considered to be alexithymic. Alexithymia has been assumed to be negatively associated with therapeutic outcome. On the other hand, it is unclear to which extent alexithymia itself may be modified by psychotherapeutic interventions. Methods: From 414 consecutively admitted inpatients, 297 were followed up after 4 weeks (t1) and after 8–12 weeks (t2) upon discharge. Patients were treated with psychodynamic group therapy in a naturalistic setting. The Toronto Alexithymia Scale (TAS-20) and the Symptom Checklist-90 were administered. Results: Twenty-seven percent of the patients were alexithymic (TAS-20 ≧61) at baseline. Multivariate models with repeated measurements indicated significant changes in Global Severity Index of the Symptom Checklist-90 in both alexithymic and nonalexithymic subjects. However, alexithymic subjects had significantly higher Global Severity Index scores than nonalexithymic subjects at t0, t1 and t2 (p < 0.001). The TAS-20 scores demonstrated a high relative stability in the total sample. However, in the alexithymic group, the TAS-20 scores changed considerably from baseline to discharge [66.3 (SD = 4.7) to 55.9 (SD = 9.9); t = 8.69; d.f. = 79; p < 0.001]. Conclusion: The inpatient treatment program including psychodynamic group therapy significantly reduced psychopathological distress and alexithymic features in alexithymic patients. Still, these patients suffered from higher psychopathological distress at discharge than nonalexithymics. Therefore, alexithymic features may negatively affect the long-term outcome.

Oral curcumin in the treatment of moderate to severe psoriasis vulgaris: A prospective clinical trial

There is a need for safe, inexpensive, and effective psoriasis therapies. Many anecdotal accounts of patients' successful treatment with the alternative medicine curcumin exist. We sought to determine the safety and efficacy of oral curcumin in patients with psoriasis. We conducted a phase II, open-label, Simon's two-stage trial of 4.5 g/d of oral curcuminoid C3 complex in patients with plaque psoriasis. End points included improvement in Physicians Global Assessment score, Psoriasis Area and Severity Index score, and safety end points throughout the study. The intention-to-treat analysis response rate was 16.7% (95% confidence interval: 2%, 48%) and both responders achieved a Psoriasis Area and Severity Index 75 score. There were no study-related adverse events that necessitated participant withdrawal. Small sample size and lack of placebo group are limitations. The response rate was low and possibly caused by a placebo effect or the natural history of psoriasis. Large placebo-controlled studies are necessary before recommending oral curcumin as a psoriasis treatment.

Effects of relationship maintenance on psychological distress and dyadic adjustment among couples coping with lung cancer.

Relationship maintenance strategies help to ensure the continuation of valued relationships by keeping them at a certain level of intimacy. This study evaluated how lung cancer patients' and spouses' efforts to maintain their relationships affected their psychological and marital adjustment over time. Psychosocial questionnaires were administered within 1 month of lung cancer treatment initiation (baseline) and 3 and 6 months later to 158 lung cancer patients and their spouses. Study outcomes were global severity index scores on the Brief Symptom Inventory, and total scores on the Dyadic Adjustment Scale. Multilevel modeling analyses using the Actor-Partner Interdependence Model showed that, regardless of gender or social role (i.e., patient or spouse), individuals who engaged in the strategies of positivity, networks, and shared tasks reported less distress at baseline than other participants. Over time, the effects of providing more assurances and experiencing a partner's increased reliance on social networks differed: patient distress was exacerbated, and spouse distress was alleviated. Couples where both partners engaged in more frequent maintenance behaviors reported greater dyadic adjustment at baseline and over time. For couples coping with lung cancer, the initial treatment period may be an important time that sets the tone for future spousal interactions. Engaging in relationship maintenance during this stressful time may help mold more resilient relationships and facilitate adjustment as the disease progresses.

Dissociation Predicts Symptom-Related Treatment Outcome in Short-Term Inpatient Psychotherapy

Previous research has indicated that dissociation might be a negative predictor of treatment outcome in cognitive behavioural therapy for patients with obsessive-compulsive and anxiety disorders. Using a naturalistic design it was hypothesized that higher levels of dissociation predict poorer outcome in inpatients with affective, anxiety and somatoform disorders participating in a brief psychodynamic psychotherapy. A total of 133 patients completed the Symptom Check List (SCL-90), the German short version of the Dissociative Experiences Scale and the Inventory of Interpersonal Problems at the beginning and the end of treatment. The Global Severity Index (GSI) of the SCL-90 was chosen as outcome criterion. A total of 62.4% of study participants were classified as treatment responders, that is, they showed a statistically significant change of their GSI scores. Controlling for general psychopathology, the non-responders had significantly higher baseline dissociation scores than the responders. In a logistic regression analysis with non-response as a dependent variable, a comorbid personality disorder, low baseline psychopathology and high dissociation levels emerged as relevant predictors, but interpersonal problems and other comorbid disorders did not. Dissociation has a negative impact on treatment outcome. It is suggested that dissociative subjects dissociate as a response to negative emotions arising in psychotherapy leading to a less favourable outcome. Additionally, dissociative patients may have an insecure attachment pattern negatively affecting the therapeutic relationship. Thus, dissociation may directly and indirectly influence the treatment process and outcome.