Long-term Group Psychotherapy Research Articles

Examining the effect of intensive individual swallowing exercise therapy protocol on swallowing physiology in geriatric patients hospitalized in the thoracic diseases service with a complaint of major swallowing dysfunction with multiple prognoses

Objectives: The study aimed to compare the effectiveness of short-term (one month) and long-term (three months) individual swallowing therapy programs in the geriatric individuals diagnosed with dysphagia by instrumental evaluation. Patients and methods: Hospital records of 31 patients (16 females, 15 males; mean age: 66.8±16.4 years; range, 66 to 83 years) were prospectively examined between April 1, 2019, and September 30, 2022. Fiberoptic endoscopic swallowing study recordings were made at the beginning of the study. The recordings were scanned and examined, and individuals with observed problems in swallowing safety and efficacy, having the same severity of dysphagia, were identified. Patients were randomly assigned to long-term (51.2%; n=16; 8 males, 8 females) and short-term (48.8%; n=15; 7 males, 8 females) therapy groups. During fiberoptic endoscopy, patients were given food of different consistencies (thin liquid, honey, nectar, pudding, and solid consistency) according to the International Dysphagia Diet Standardization Initiative protocol, and they were evaluated before therapy and one week, one month, and three months after therapy using the penetration-aspiration scale and the Yale Pharyngeal Residue Severity Scale-Vallecula/Pyriform Sinus. Functional Oral Intake Scale and Turkish Eating Assessment Tool-10 (T-EAT-10) results were compared between the groups. An exercise-based individual swallowing therapy program of one and three months was applied to short-term and long-term therapy groups, respectively. Results: When the post-therapy penetration aspiration scores and pharyngeal residual severity scores of individuals receiving long-term and short-term therapy were compared, a higher score was found in the group receiving shortterm therapy than the long-term group, and a significant difference was found (p<0.001). Pharyngeal phase abnormalities were detected in 27 (88.4%) patients, whereas laryngeal penetration/aspiration status was found in 23 (75.3%) patients, and both variables were found to be significantly higher in the short-term group (p=0.015 and p=0.014, respectively). The T-EAT-10 scores obtained before therapy in the long-term therapy group were significantly higher than T-EAT-10 scores obtained at the third month after therapy (p=0.004, p<0.001, and p<0.05, respectively). Silent aspiration of thin liquid, nectar, and solid consistency was experienced in 78% of patients before therapy. Conclusion: Long-term swallowing therapy program appears to be more effective than short-term in geriatric individuals with dysphagia.

Patients’ Perspective on the Important Therapeutic Factors in Integrated Systemic Group Therapy: A Phenomenological Approach

ABSTRACT This qualitative research refers to the patients’ perspective on the therapeutic factors operating in long-term group therapy of an integrated systemic orientation (ISO). Semi-structured interviews of members of two long-term ISO psychotherapy groups were conducted in three phases: the first, second, and third year of their group psychotherapy. The research sample consisted of 13 participants. The data was analyzed through an interpretative phenomenological analysis. The results confirmed the classification of Yalom’s therapeutic factors. However, an additional therapeutic factor emerged, the “development of pluralistic perspectives” that appears more clearly from the second year of therapy onward. Moreover, from the second year onward, the categories “existential factors” and “interpersonal learning” get strengthened. Limitations and future directions are discussed.

Variation in information needs of patients with interstitial lung disease and their family caregivers according to long-term oxygen therapy: a descriptive study

BackgroundThe information needs of patients and their families regarding interstitial lung disease (ILD) have yet to be studied in detail, and few reports have examined the differences in information needs according to patient status. This study aimed to determine whether there are differences in information needs between outpatients with ILD and their family caregivers and whether these differences depend on long-term oxygen therapy use.MethodsPatients with fibrotic ILDs and their families who visited Kyoto University Hospital between February 2020 and March 2022 were recruited for this descriptive study. Fibrotic ILDs included idiopathic pulmonary fibrosis (IPF), other idiopathic interstitial pneumonias (IIPs) than IPF, connective tissue disease-associated ILD (CTD-ILD), and fibrotic hypersensitivity pneumonia. Data were obtained from electronic patient records and questionnaires. Descriptive data analyses were performed.ResultsSixty-five patients and their family caregivers were analyzed. Twenty-seven (41.5%) patients had IIPs (IPF 9 and other IIPs 18), 34 (52.3%) had CTD-ILD, and 4 (6.2%) had fibrotic hypersensitivity pneumonia. The most common relationship between the patient and their family was a spouse (67.7%), with 80% living together. The primary information needs among patients and their family caregivers were common up to the third rank but differed from the rest. Patients were interested in “when and where to contact health care providers” and “end-of-life care and advanced directives,” while family caregivers were interested in “diet and nutrition” and “care and support at home.” Patients with long-term oxygen therapy had higher needs for “end-of-life care and advanced directives” and “how to manage breathlessness, cough, and fatigue,” while the needs for “drugs for ILD” and “acute exacerbation of ILD” were relatively low. Family caregivers were interested in “diet and nutrition” in the long-term oxygen therapy group and “acute exacerbation of ILD” in the no long-term oxygen therapy group.ConclusionsThis study found that the information needs of patients and their family caregivers were not the same and that the aspect of information needs differed by long-term oxygen therapy status. Healthcare providers should consider the position of the recipient of information, the appropriate time based on the patient’s condition, and the necessary information.

Effect of a long-term art-based group therapy with eating disorders

Eating disorders (EDs) affect the physical, psychological, emotional and interpersonal areas of the individual and cause serious medical and mental consequences. Their treatment should be handled in a multidisciplinary manner.The...

Steroid supplementation before minor oral surgical procedures in patients taking long-term glucocorticoids: A triple-blinded, randomized, placebo-controlled trial

BackgroundPatients undergoing long-term glucocorticoid therapy are administered additional glucocorticoids before minor dental procedures, although this is not supported by evidence. The authors designed this study to validate the hypothesis that routine blanket glucocorticoid supplementation is unnecessary during minor oral surgical procedures under local anesthesia. MethodsThe authors recruited 270 patients into 3 groups (1:1:1 allocation) from the dental outpatient department. Primary outcomes were changes in hemodynamic parameters and frequency of adverse events among the 3 groups. The secondary outcome was the association of preprocedural stress and procedural pain with periprocedural adverse events in the long-term glucocorticoid therapy group (groups I and II). ResultsNo clinically relevant changes in hemodynamic parameters among the 3 groups were found. The authors also found low periprocedural adverse events in all 3 groups combined (n = 1), so they did not explore the secondary outcomes further. ConclusionsAmong patients undergoing long-term glucocorticoid therapy for indications other than primary adrenal insufficiency, elective minor oral surgical procedures can be performed safely with only their daily dose of glucocorticoid when their medical conditions are optimized. Routine additional glucocorticoid supplementation appears unnecessary. The results of the study also revealed opportunities for value addition by means of integrating oral health care with medical follow-up for patients with multiple co-occurring medical conditions. Practical ImplicationsRoutine blanket glucocorticoid supplementation among patients taking a long-term glucocorticoid for indications other than primary adrenal insufficiency appears unnecessary before minor oral surgical procedures under local anesthesia. This clinical trial was registered at Clinical Trial Registry-India. The registration number is CTRI/2017/02/007779.

Short-Term Vs. Long-Term Glucocorticoids in COPD Exacerbation: A Comparative Efficacy Study

The current study aims to evaluate the comparative efficacy of short-term and long-term glucocorticoid treatment in patients with COPD exacerbation. A randomized clinical trial will compare the effectiveness of short-term and long-term glucocorticoid treatments in COPD exacerbation. One hundred ninety patients will be recruited and randomized into two groups: a short-term glucocorticoid group and a long-term glucocorticoid group. The primary outcomes will be assessed at the end of the treatment period to determine the efficacy of the treatments. Secondary effects will include quality of life, length of hospitalization, and adverse events. The results of this study will provide insight into the comparative efficacy of short-term and long-term glucocorticoid treatments in COPD exacerbation. Objective: Comparative efficacy of short-term (5-days) versus long-term (10-days) glucocorticoids at equivalent doses in managing COPD patients with acute exacerbations. Materials and Methods: Pakistan Institute of Medical Sciences (PIMS), Islamabad, conducted this randomized clinical trial in the inpatient pulmonology department. This research took six months following ethical clearance. The experiment included 190 patients in two groups of 95. Patients in the two groups were randomly administered Tab—prednisolone 5mg (40mg/24 Hours) for five days or ten days. Using a carefully constructed pro-forma, postgraduate residents gathered data on five parameters (FEV1, FEV1/FVC, Arterial Blood Gases, mMRC Dyspnoea Scale, Sputum color and amount, presentation with identical symptoms within 30 days following discharge). Results: Patients averaged 58.13 ± 11.12. Long-term patients were 58.34 ± 11.53 years old, whereas short-term patients were 57.93 ± 10.752. The short-term group included 86 (90.53%) male and 9 (9.47%) female cases, whereas the long-term group had 89 (93.68%) male and 6 (6.32%) female cases. Sputum color was normal in all groups after therapy. Short-term and long-term therapy groups had mean FEV1 changes of 8.12±4.85 and 7.14± 1.75, respectively. Following treatment, short-term mMRC was significantly lower (2.14±0.32) than long-term (2.73±0.44), with p-value < 0.001. The short-term group mMRC mean change was 1.67±0.53 compared to the long-term group 1.07±0.26, p-value < 0.001. Sputum amounts changed by 2.63 ± 1.67 in the short-term and 2.49 ± 0.72 in the long-term groups. Both groups had similar mean sputum quantities before, after, and after treatment, with a p-value > 0.05. Both groups had the same ABG parameter mean change following therapy. One month after discharge, neither group relapsed. Conclusion: The efficacy of short-term (5-days) glucocorticoids is better than long-term (10-days) glucocorticoids at equivalent doses in terms of mMRC reduction. At the same time, the therapeutic effect was statistically the same in both groups regarding improvement in FEV1, sputum color, sputum quantity, all parameters of ABGs, and relapse rates. Keywords: COPD, exacerbation, glucocorticoids, efficacy

Effect of different antibiotic therapies on the reproductive outcomes of fresh embryo transfer for chronic endometritis: A retrospective cohort study.

To investigate the reproductive outcomes by comparing two kinds of antibiotic schemes for chronic endometritis (CE) in infertile women's fresh embryo transfer (FET) cycles and identify subgroups of patients with CE who need long-term antibiotics treatment. A retrospective cohort study. University-based reproductive medical center. A total of 492 women with CD138-positive plasmacytes per 10 high-power fields (CD138+/10HPF). Hysteroscopy was performed and endometrial biopsy samples were collected in the proliferative phase. Long-term or short-term antibiotics were administrated. After antibiotics treatment, patients underwent in vitro fertilization (IVF)/ intracytoplasmic sperm injection (ICSI) and received ET. Ongoing pregnancy rate, clinical pregnancy rate, clinical miscarriage rate. There were no significant differences in pregnancy outcomes between patients with CD138+/10HPF 1-4 (low-grade CE) who received long-term antibiotic therapy and short-term antibiotics groups. Among women with CD138+/10HPF ≥5 (high-grade CE), live birth rate (48.4%vs. 14.7%, p=.001), clinical pregnancy rate (66.7%vs. 35.3%, p=.002) and ongoing pregnancy rate (59.1%vs. 20.6%, p<.001) in the long-term arm were significantly higher than that in the short-term arm. The clinical miscarriage rate (21.0%vs. 58.3%, p=.013) was statistically lower in the long-term antibiotics group, but no statistical differences were found between the two groups in preterm delivery rate. Long-term antibiotics treatment was a sensible choice to improve pregnancy outcomes in women with CD138+/10HPF ≥5 (high-grade CE). The pregnancy outcomes of women with low-grade CE only defined by histological diagnosis were not greatly improved after antibiotic therapy. Therefore, we recommended the proper diagnosis criteria were CD138+/10HPF ≥5 pathologically.

Was geht „kurz“ in psychodynamischen Gruppenbehandlungen? Ein Therapieangebot aus der Praxis und ein vorsichtiges Plädoyer für neue Wege und neue Diskussionen

Referring to Manuel Becker’s article about new German legal options of short-term group therapy in this journal (2021, 57, S. 167-186) we reflect upon the impact factor of restricted time in psychodynamic group therapy and present a compact offer of short-term group therapy on three weekends, developed in clinical practice. We consider this concept a module between the new primary group therapeutic care and long-term psychodynamic group therapy. Feed-back and ideas of colleagues are welcome.

Θεραπευτική σχέση και μακρόχρονη ομαδική συστημική ψυχοθεραπεία: μια ποιοτική προσέγγιση

The therapeutic relationship has been highlighted as a major mechanism of therapeutic change in current literature. Existing research has focused on certain qualities of the therapist, such as empathy, acceptance and authenticity, as well as of the client, such as the quality of their interpersonal relationships and their expectations, which enhance the therapeutic alliance. Less is known about the importance of the therapeutic relationship in long-term systemic group therapy. Ten semi-structured interviews were conducted with clients who had completed long-term group therapy following an enriched systemic approach SANE - System Attachment Narrative Encephalon®. Participants were invited to talk about their personal experience of group therapy 2-8 years after its completion. Three higher order themes and six subthemes emerged related to the therapeutic relationship. The higher order themes are: (1) the role of the therapist; (2) the function of the therapist; (3) the qualities of the therapist. The subthemes are: 1.a) the therapist as a source of safety; 1.b) the therapist as a parental role model; 2.a) the expression of the therapist’s feelings; 2.b) the client’s transition from dependency to autonomy; 3.a) the therapist’s personality traits; 3.b) the therapist’s professional role fulfillment. The study aims to contribute to the bibliography of process research of long term group therapy from the clients’ perspective, in order to clarify the parameters of the therapeutic relationship the clients consider more important and helpful.

“If you don’t have a word for something, you may doubt whether it’s even real” – how individuals with borderline personality disorder experience change

Objective: This study explored how psychological change was experienced and what treatment-related factors or events were perceived as supporting or hindering their process by individuals with borderline personality disorder. Methods: Eight BPD sufferers attended a 40-session psychoeducational group intervention at a community mental health care center. At intervention end, personal experience of meaningful change was explored in an in-depth interview and data were content-analyzed. Change in BPD symptoms was assessed by the Borderline Personality Disorder Severity Index IV interview. Results: The qualitative content analysis on subjectively perceived meaningful change yielded three core categories: (1) improved ability to observe and understand mental events, (2) decreased disconnection from emotions, emergence of new or adaptive emotional reactions and decrease in maladaptive ones, and (3) a new, more adaptive experience of self and agency. Accordingly, (1) learning and (2) normalizing emerged as the main categories of helpful treatment factors. In turn, treatment-related factors perceived as obstacles were: (1) aggression in the group, and (2) inflexibility. With respect to symptom change, four participants were considered clinically as remitted, and two showed a reliable change. Conclusions: Long-term psychoeducational group therapy seems to enhance mentalization / metacognitive functioning and promote self (or personality) integration in BPD patients.

Sexual Dysfunction: A Neglected and Overlooked Issue in Adult GH Deficiency: The Management of AGHD Study.

ContextAlthough sexuality influences well-being and quality of life (QoL), studies on sexual dysfunction (SD) in adult growth hormone deficiency (AGHD) patients are lacking.ObjectiveTo investigate the prevalence of SD in AGHD patients grouped according to recombinant human growth hormone (r-hGH) therapy.DesignProspective, cross-over, 24 months, monocentric study.SettingReal-life clinical setting in a tertiary, endocrinological center.Patients83 AGHD patients (31 women, 52 men, mean age 56.3 ± 14.7 years) were enrolled according to stringent criteria.Intervention(s)Patients already on long-term r-hGH therapy (Group 1, n = 32) vs untreated (Group 2, n = 51).Main outcome measure(s)Serum hormones, QoL Satisfaction in Hypopituitarism (QLS-H) and QoL Assessment of GHD in Adults (QoL-AGHDA) questionnaires for QoL, Index for Erectile Function-15 (IIEF-15) in men, and Female Sexual Function Index (FSFI) in women for SD.ResultsThe overall prevalence of SD was 71.2% (60% men, 89% women). All IIEF-15 scores were lower (P = 0.001) and erectile dysfunction was more prevalent in Group 2 (75%) than Group 1 (35%). IGF-1 was correlated to scores of all IIEF-15 domains, particularly with that of erectile function (EF) (R2=0.123, P = 0.019). EF domain score correlated with QLS-H (P < 0.005) and QoL-AGHDA (P = 0.001). Despite the high prevalence of female SD also in untreated AGHD women, FSFI scores did not correlate with IGF-1 levels and QoL scores.ConclusionsSD is highly prevalent in AGHD patients, especially in those untreated. SD represents an overlooked and neglected issue in AGHD, regardless the contribution of sexual life on QoL. The evaluation of sexual function should be integrated in the global assessment of AGHD patients.

Efficacy of Long-Term Oral Beta-Blocker Therapy in Patients Who Underwent Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction With Preserved Left Ventricular Ejection Fraction: A Systematic Review and Meta-analysis.

After the results of the first multicenter, prospective randomized clinical trial (RCT) evaluating long-term efficacy of oral beta-blockers in patients with preserved left ventricular ejection fraction (LVEF) after ST elevation myocardial infarction (STEMI), we decided to conduct an updated systematic review and meta-analysis to evaluate the long-term efficacy of oral beta-blocker use in patients with preserved LVEF who underwent percutaneous coronary intervention (PCI) for STEMI. A time-limited search from January 1, 1999, to April 16, 2020, on PubMed and EMBASE was conducted on April 16, 2020, for observational studies and clinical trials evaluating the efficacy of long-term oral beta-blockers in patients with preserved LVEF after STEMI treated with PCI. The comparative outcomes between beta-blockers and non-beta-blockers were assessed by pooling weighted odds ratio (OR) with 95% confidence interval (CI) using random-effects model. The outcomes of interest were all-cause mortality and major adverse cardiac event (MACE). Twelve studies (11 observational and 1 RCT) comprising 32,108 patients (19,740 on beta-blocker therapy and 12,368 without beta-blocker therapy) were included. Of which, 75% percent were male (mean age of 64 years: 63.87 ± 3.01 years on beta-blocker therapy and 64.76 ± 3.02 years on non-beta-blocker therapy; P = 0.129) with a follow-up of up to 4.7 years. Unadjusted all-cause mortality [OR = 0.58 (95% CI: 0.42-0.79)] and adjusted all-cause mortality [OR = 0.64 (95% CI: 0.48-0.87)] were significantly lower in patients on the long-term beta-blocker therapy group. However, unadjusted MACE [OR = 0.87 (95% CI: 0.70-1.08)] was not reduced with beta-blocker therapy in these patients. Patients with preserved LVEF after STEMI treated with PCI on long-term oral beta-blocker therapy have a significant reduction in risk of all-cause mortality, without an effect on MACE rates. The only RCT included showed neutral effect, so results of ongoing RCTs are anticipated. Considering that the only high-quality data (RCT) suggest a neutral effect, one should be cautious in interpreting the conclusion.

SUN-464 Trunk Fat Increase Is Prevented Both in Patients Undergoing Long-Lasting Continuous r-hGH Therapy and in Those Who Discontinued r-hGH Compared to Untreated Patients: Results from Baseline Data of the MAGHD Study

Background: Adult-onset growth hormone (GH) deficiency (AGHD) is related with alterations in body composition, increased abdominal and visceral adiposity, adverse change in lipid and carbohydrate metabolism, and reduction of bone mineral density (BMD). Aim: To compare body composition and biochemical/hormonal data among adult patients with AGHD referring to a single endocrinological center and grouped according to r-hGH therapy. Methods: The Manage Growth Hormone Deficiency Study (MAGHD) is a prospective, single-center trial aiming to improve AGHD management through a smartphone app (MAGHD App: Manage AGHD) integrated with a software framework able to merge several kind of patients’ daily data with clinical data collected in institutional databases. Up-to-now, a total of 74 subjects (26 Female, 48 Male, mean age: 56.6+14.8 years) with AGHD, fulfilling the inclusion criteria, were enrolled in the study. According to r-hGH therapy, they were divided in 3 groups: patients on long-term r-hGH therapy (Group 1, n=33), patients previously treated with r-hGH, who had stopped the therapy at any time (Group 2, n=18), patients never treated (Group 3, n=23). Each patient has completed the baseline visit, including biochemical and hormonal measurements and data on BMD and body composition obtained by DXA. The nonparametric Kruskal-Wallis test was used for comparison among 3 groups and data are expressed as median. Results: Mean duration of AGHD disease of the entire cohort was 121.2+105.8 months; it was lower in Group 3 compared to both Group 1 and 2 (p<0.05). Waist circumference (Group 1 95 cm; Group 2 96,5 cm; Group 3 109 cm) and trunk fat mass (Group 1 539 g; Group 2 525 g; Group 3 595 g) were significantly higher in Group 3 compared to both Group 2 and 1 (p<0.05). Serum insulin, total fat mass, and total body fat (%) were significantly higher in Group 3 than Group 1 (p<0.05). IGF-1 and IGFBP3 were significantly higher in Group 1 compared to both Group 2 and 3 (p<0.0001). BMD, circulating lipids, and fasting glucose did not differ among the 3 groups. Conclusions: r-hGH therapy seems to confer a long-lasting beneficial effect on body fat, especially trunk fat even after its discontinuation in AGHD patients, but not on metabolic parameters. Acknowledgment: This clinical study is conducted thanks to the competitive assignment of an Independent Grant for Learning & Change (“IGCL”) Dissemination & Implementation (“D&I”) by Pfizer Inc.

Validation of a simple test, the Timed Up and Go test, to assess the risk of falling in patients with chronic obstructive pulmonary disease

Risk of falling in patients with chronic obstructive pulmonary disease (COPD) is an emerging issue, but little studied. It could affect up to 50% of patients entering respiratory rehabilitation, with an increased prevalence in severe stages of the disease. Falling risk evaluation is usually carried out by the Berg Balance Scale (BBS score), which is difficult to use in current practice given a long realization time. Thus, validation of a simple and quicker screening test is essential. The Timed Up and Go test (TUG), validated in geriatrics, could be an interesting screening test for people with COPD. We collected self-reported falls number in the previous year, assessed the fear falling (ABC-scale), the risk of falling (BBS score) and performed a TUG test. In addition, we measured predictive parameters of falling: muscle mass, quadriceps muscle strength, walking distance in 6 min (TM6). Of the 50 COPD patients included, 23 patients (46%) had at least one fall during the last year; this percentage was higher in long-term oxygen therapy (LTOT) group (68 versus 24% for LTOT-group, P < 0.005). TUG correlates very well with BBS score ( r = −0.92, P < 0.0001), and there is also a very good agreement between the two tests (κ=0.92, P < 0.0001). Optimal diagnosis value for the TUG with the best sensitivity/specificity ratio is 10.9 seconds with a sensitivity of 100% and a specificity of 97%. Analysis of falling predictive factors regains severity of COPD evaluated by various pulmonary parameters, alteration of quadriceps muscular strength, TM6, as well as a possible proprioception impairment. These results confirm the high prevalence of falls in a population of stable COPD subjects, especially since there is a chronic hypoxia. TUG represents a simple falling risk screening test in these patients to enable more specific rehabilitation by adding proprioceptive and neuromotor control work to respiratory rehabilitation programs.

The Iowa Personality Disorder Screen: A validation study in a psychiatric population that receives long-term group psychotherapy for personality related problems.

Personality disorder (PD) is common among psychiatric patients, and diagnosing such disorders is of great importance for the choice of treatment. Diagnosing PD is a demanding and time-consuming process. The utilities of several PD screening instruments have been studied in different populations, but not in a population who receives long-term group psychotherapy. In the current study, we investigate the predictive properties of the Iowa Personality Disorder Screen (IPDS) in a sample of 694 psychiatric outpatients with and without PD who were admitted for psychodynamic long-term group therapy from 2012 to 2014. The definitive, reference diagnoses were defined according to the SCID-II, by which 484 patients (68%) warranted a PD diagnosis. The IPDS correctly classified 67.4 percent of all participants. Sensitivity (0.75) and specificity (0.51) were lower than in previous validation studies of IPDS. We discuss possible explanations related to the general concept of PD and, more specifically, to our study sample. Because of the weaker predictive properties of IPDS, we advise caution in use of the IPDS in similar clinical settings. Copyright © 2018 John Wiley & Sons, Ltd.

SUV as a Possible Predictor of Disease Extent and Therapy Duration in Complex Tuberculosis.

F-FDG PET/CT provides information on disease extension and activity in neoplastic and inflammatory conditions. So far, little is known about whether SUVmax of a reference lesion can allow a prognosis to be given regarding patient-specific outcome parameters in complex cases of tuberculosis (TB). We retrospectively identified 37 patients (21 men, 16 women; mean age, 50.4 years) who underwent F-FDG PET/CT for the evaluation of active TB before treatment initiation. The aims were to examine whether the reference lesion SUVmax differed between patients with standard (≤9 months) and long-term (>9 months) therapy and to define an SUVmax cutoff distinguishing those groups. In addition, we analyzed the prognostic value of SUVmax with regard to estimation of initial disease extent and lesion distribution pattern. Median therapy duration was 10 months (interquartile range, 3.25 months), and median SUVmax was 8 (interquartile range, 8.54). SUVmax was significantly (P = 0.036) higher in patients treated longer than 9 months (10.1 vs 5.5). When applying a receiver operating characteristic curve analysis, an SUVmax cutoff value of 10 differentiated the standard and the long-term therapy group with a sensitivity of 50% and a specificity of 78.6% (P = 0.087). Higher SUVmax corresponded with a larger number of affected organ systems (P = 0.012 for ≤/>1). Patients with extrathoracic involvement showed significantly higher SUVmax than did patients with limited intrathoracic disease (P = 0.024) and received significantly longer antimycobacterial therapy (P = 0.011). Reference lesion SUVmax from pretherapy F-FDG PET/CT may have prognostic properties in complicated cases of TB, especially regarding therapy duration and disease extent.

The effects of psychostimulants on oral health and saliva in children with attention deficit hyperactivity disorder: A case-control study.

This study investigated the dental health problems and saliva characteristics of children under psychostimulant therapy for attention-deficit hyperactivity disorder (ADHD). One hundred and twenty children aged 7-12 years were divided into three groups. Groups 1-2 comprised children diagnosed with ADHD: those who had not yet started psychostimulant therapy (Group 1) and those already receiving long-term psychostimulant therapy (Group 2). Group 3 comprised healthy, nonmedicated children. Possible side effects of psychostimulants were investigated at the beginning of study in Group 2 and after 3 months drug use in Group 1. Bruxism and dental erosion prevalence, salivary Streptococcus mutans count, buffering capacity, and stimulated salivary flow rate (SSFR) were measured, and salivary α-amylase, calcium, total protein, and proline-rich acidic protein (PRAP) levels were quantified in the beginning of the study. Data were analyzed using the Kruskal-Wallis test. The most frequently reported side effects of psychostimulants were decreased appetite, dry mouth, and increased fluid consumption. The prevalence of bruxism and dental erosion was higher in Groups 1 and 2 than in Group 3, but the differences were not significant (P > 0.05). In Group 2, subjective dry mouth feel was reported by 32.5% of patients and 17.5% had a very low SSFR. Salivary α-amylase, calcium, total protein, and PRAP levels were lower in Group 2 than the others, but the differences were not significant (P > 0.05). ADHD and psychostimulant therapy do not appear to be significantly related to decreasing SSFR or protective saliva components against dental caries. However, a systematic investigation of the long-term safety of psychostimulants is needed. The most effective method of maintaining dental health of children with ADHD is frequent appointments focusing on oral hygiene practices accompanied by dietary analyses.

Effects of Group Psychotherapy in College Students: A Six and Twelve Month Evaluation Comparison

Group psychotherapy expects to afford more lasting changes on patients’ symptomatology, as well as reinforce positive aspects of self-esteem and social adjustment. However, few investigations show the effects over an extended period of intervention. This study aimed to assess changes in symptoms of anxiety, depression, self-esteem and social adjustment within a period of six and twelve months in college students who attended interactional group psychotherapy. A longitudinal study was carried out with college students who attended group psychotherapy, using the database of forty-one of the students who stayed for six months and 23 of them, for 12 months. Significant improvements were observed at 6 and 12 months in anxiety-state and depressive symptoms compared to baseline data, but there were no changes between 6 and 12 months. The comparison between well-being aspects such as self-esteem and social adaptation showed improvements mostly, up to 12 months, without any significant changes between 6 and 12 months. Also, there was observed a correlation between well-being punctuations (self-esteem and social adaptation) and the decrease of depressive and anxiety symptomatology. Long-term group psychotherapy demonstrates a decrease of symptomatology at six months of intervention, and they remain at 12 months; however, other aspects of patient’s well-being, are enhanced to a higher level until 12 months.

Developing a group-analytic culture in a day project for psychotic patients

This article describes the flexible application of group-analytic principles in a long-term group psychotherapy programme for psychotic patients, within the wider containing structure of a weekly day project in a community setting. Clinical vignettes illustrate the steady development of a benign group therapeutic culture which helped patients achieve deeper levels of communication and understanding, resulting in better functioning and a greater capacity to cope with everyday life and establish satisfactory relationships. Reference is made to some of the relevant literature as back-up to evidence-based practice. The paper aims to stimulate further group case studies and process research with this population, as well as to encourage practitioners to increasingly use psychodynamic therapy groups in the treatment of psychosis.

Long-term Group and Premature Drop out Groups in Psychotherapy: Yalom's 'Here and Now' Techniques

The Yalom's 'here-and-now' techniques-activation and illumination is worked particularly in each session of long-term group psychotherapy. Both activation and illumination help therapist interpret, reflect, and clarify individual's behaviors. In the premature, dropping out of group, the therapist also used both in order to do following benefits: reduce the clients' psychological distress, increase individual's self-esteem, and foster client's hope in group session as well as maintain positive outcome of long-term group psychotherapy. The volunteers in long-term group psychotherapy of the Thai Psychotherapist Association was observed and recorded the 'here-and-now' techniques by an observer when the premature drop out presented in the group process. The result of this study showed that most of Yalom's 'here-and-now' activation was demonstrated in premature drop out group.