Naturalistic Treatment Setting Research Articles

Validation of a behavioral health treatment outcome and assessment tool designed for naturalistic settings: The Treatment Outcome Package

In 1994, the American Psychological Association and the Society for Psychotherapy Research convened a Core Battery Conference to develop a set of criteria for the selection of a universal core battery that could be used as a common outcome tool across all outcome studies. The Treatment Outcome Package (TOP) is a behavioral health assessment and outcome battery with modules for assessing a wide array of behavioral health symptoms and functioning, demographics, case-mix, and treatment satisfaction. It was developed to follow the design specifications set forth by the Core Battery Conference, but also to ensure the battery's applicability to naturalistic treatment settings in which randomization may be impossible. In this article we discuss a number of studies that evaluate the initial psychometrics of the items that comprise the mental health symptom and functional modules of the TOP. We conclude that the TOP has an excellent factor structure, good test-retest reliability, promising initial convergent and discriminant validity, measures the full range of pathology on each scale, and has some ability to distinguish between behavioral health clients and members of the general population.

Topiramate and divalproex in combination with risperidone for acute mania: a randomized open-label study

Mood stabilizers and atypical antipsychotics are commonly combined for the treatment of bipolar mania. The aim of this study was to compare the effectiveness and tolerability of topiramate and divalproex in combination with risperidone for treating acute mania patients in a naturalistic treatment setting. Seventy-four patients who met the DSM-IV criteria for bipolar mania were enrolled in this study. In order to assess the efficacy and the extrapyramidal symptoms (EPS), the Young Mania Rating Scale (YMRS), Clinical Global Impression (CGI) and Simpson–Angus Rating Scale (SARS) were measured at the baseline and at weeks 1, 3 and 6. From the baseline to the endpoint, the YMRS and CGI scores were reduced by 67.9% and 56.6% in the topiramate plus risperidone group (TPMG). The YMRS and CGI scores were also reduced by 63.7% and 58.2% in the divalproex plus risperidone group (DVPG). The weight and body mass index (BMI) increased significantly by 3.6% and 3.3% from the baseline to the endpoint in the DVPG, while they decreased by 0.5% and 0.4%, respectively, with no significant difference in the TPMG. There were no serious adverse events in either group. Despite the methodological limitations, topiramate was effective and tolerable for treating acute mania and may also be a promising alternative to a weight-gain liable mood stabilizer (MS) such as divalproex.

Switching to quetiapine in patients with acute mania who were intolerant to risperidone.

This study evaluated the overall efficacy and tolerability of quetiapine in the treatment of inpatients with acute mania who are intolerant to risperidone in combination with a mood stabilizer. Eighteen patients completed this 3-week trial. The efficacy and tolerability was assessed upon admission, at baseline, and 1 and 3 weeks later. The Young mania rating scale (YMRS) and clinical global impression-severity (CGI-s) scores from the baseline to the endpoint, decreased by 39.8% and 40.0%, respectively. Fifteen (78.9%) and 18 (94.7%) patients exhibited at least a 50% improvement in the YMRS and CGI-s scores by the end of the trial. Measurements taken through the Barnes akathisia rating scale (BARS), the Simpson-Angus rating scale (SARS) and the drug attitude inventory shortened version-10 (DAI-10) also showed significant improvement. This study suggests that quetiapine may hold promise as an alternative regimen that does not worsen the psychopathology, particularly for those vulnerable to the side effects of drugs, including atypical agents such as risperidone, in naturalistic treatment settings.

P.4.009 Cholinesterase inhibitors reduce the risk of institutionalization in patients with dementia in a naturalistic treatment setting

P.4.009 Cholinesterase inhibitors reduce the risk of institutionalization in patients with dementia in a naturalistic treatment setting

Group Cognitive Behaviour Therapy for Residual Depression: Effectiveness and Predictors of Response

To date, there is a lack of evidence on the effectiveness of cognitive behaviour therapy for residual depression in naturalistic treatment settings. Previous reports have indicated that perfectionism and self-criticism may be predictive of poor response to individual cognitive behaviour therapy for acute depression. However, no studies of the impact of these cognitive variables on the outcome of treatment for residual depression have been reported. Accordingly, we sought to evaluate the effectiveness of a group cognitive behaviour therapy program for residual depression and to assess the impact of self-criticism, self-oriented perfectionism and socially prescribed perfectionism on the outcome of this treatment. Sixty-five patients (44 women) with residual symptoms (Beck Depression Inventory score >8) following medication treatment for major depression completed measures of depression, functional status, self-criticism, self-oriented perfectionism and socially prescribed perfectionism before and after 12 sessions of group cognitive behaviour therapy. Depression symptoms and functional status both showed significant change over the course of treatment (Cohen's d = 0.62 and 0.39, respectively). Pre-treatment self-criticism scores and change scores (pre- to post-treatment) for self-criticism and socially prescribed perfectionism were associated with the symptomatic and functional outcome of treatment. The results suggest that group cognitive behaviour therapy may be a useful and cost-effective treatment for residual depression in a tertiary care setting that uses predominantly prescriptive treatment.