Patients In Therapy Group Research Articles

Endothelium-dependent mechanisms of nephroprotective effect of renin-angiotensin system modulators in patients with essential hypertension

Introduction. It has been shown that essential hypertension (EH) is one of the main causes of end-stage renal failure in 10-30% of patients on programmed hemodialysis. At the same time, according to some clinical studies, it was shown that the most widely used drugs (diuretics, beta-blockers, calcium channel antagonists, etc.) effectively reduce high blood pressure (BP), are able to prevent the development of myocardial infarction and cerebral catastrophes, however, do not have a sufficient nephroprotective effect.The aim of the study is to identify the nephroprotective efficacy of angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists in patients with EH.Materials and methods of research. To achieve this goal, 40 patients with stage I-II EH with a level of I-III degree of arterial hypertension at the age of 34 to 63 years (mean age 45.8±1.14 years) were examined, without adequate systematic antihypertensive therapy, in which, as a result of a complex clinical-anamnestic and instrumental-laboratory research, there were no data which can indicate on the presence of manifest hypertensive nephropathy and other clinically significant expressed signs of chronic kidney diseases.Research results. Evaluation of the obtained results showed that patients of both groups had a significant antihypertensive effect: the decrease in systolic BP and diastolic BP at the end of the course of therapy in patients of group 1 was 18.24% and 15.67%, in the group 2 was 17.32% and 15.44 %, respectively. The dynamics of urinary albumin excretion at the end of the course of therapy was also found to be reliable in comparison with the primary data: in the treatment with enalapril the level of albuminuria decreased by 25.13%, excretion of β2-microglobulin decreased by 18.82%. In group 2, the decrease in these indicators was 16.34% and 17.46%, respectively (p <0.05). It should be noted a statistically significant decrease in glomerular permeability index, an indirect marker of intraglomerular hypertension: for patients in group 1 by 19.14%, for patients in group 2 by 14.12%, respectively. Evaluation of the effectiveness of the treatment on the functional state of the kidneys in the examined patients with EH showed that in 19 patients (82.61%) of the 1st group and in 15 patients (68.18%) of the 2nd group, therapy was regarded as effective.Conclusions. Therapy with enalapril and irbesartan has a significant antihypertensive and nephroprotective effect. Evaluation of indicators characterizing the functional state of the kidneys in patients with essential hypertension during therapy indicates that enalapril has a more pronounced nephroprotective effect in comparison with irbesartan. The effectiveness and rationality of nephroprotective therapy is largely determined by the positive dynamics in the reserve capacity of the kidneys and in the restoration of the functioning of the vascular endothelium.

The auto-call as an impactful technical tool in increasing adherence to lipid-lowering therapy and patient outcome in ambulatory settings: 1-year experience at tertiary cardiology center

Abstract Background Long-term adherence to lipid-lowering treatment is a challenge. Purpose To develop a technical tool, an auto-call program, aimed to increase patient adherence to lipid-lowering therapy, and patient outcome in ambulatory care. Methods 919 ambulatory patients were studied, divided to three groups: with low or moderate risk of developing atherosclerosis complications (Group 1); with high or very high risk of atherosclerosis complications, but without coronary artery disease (CAD) symptoms (Group 2); patients with symptomatic CAD (Group 3). At baseline, patients were invited to participate in the auto-call program (call-reminder to take the medication); the duration of study was 1 year. 663 patients (71.3%) consented to auto-calls received, 256 patients (28.7%) declined auto-calls. These two groups were comparable according to age, gender, the presence of comorbidities, the level of baseline adherence to lipid-lowering therapy, and the level of anxiety and depression. Treatment adherence was evaluated using Morisky-Green Medication Adherence Scale. Results Group 1. After 1 year, the auto-call group showed a significantly higher degree of decrease in low-density lipoprotein cholesterol, LDL-C (p=0.001) and triglyceride, TG (p=0.002), and increase in high-density lipoprotein cholesterol, HDL-C (p=0.03) compared to the auto-call rejection group. Group 2. After 1 year, the auto-call group showed a significantly higher degree of decrease in total cholesterol, TC (p<0.02) and LDL-C (p<0.01), and increase in HDL-C (p=0.2) compared to the auto-call rejection group. Moreover, in the auto-call group, the baseline TC level was higher (6.4±1.5 mmol/l vs 6.0±1.4 mmol/l, p=0.03). Group 3. After 1 year, the auto-call group showed a significantly higher degree of decrease in TC (p<0.005) and TG (p<0.05). The degree of decline in LDL-C was higher in the auto-call group (−25.9 (−27.3; −17.0) vs −20.1 (−21.3; −0.2), however, non-significant. After 1 year, treatment adherence increased in the total cohort from 1.91 score (1.80; 2.02) to 2.6 score (2.52; 2.80), p<0.000001. However, in Group 3, a significant increase in scores from 2.0 (1.9; 2.2) to 3.0 (2.6; 3.1) was observed only in the auto-call group (p<0.00001). In Group 1 and Group 2, the increase in adherence did not depend on the presence or absence of auto-calls. It should be noted that adherence to therapy in patients of Group 3 was significantly higher at baseline (2.0 (1.9; 2.2) than in Group 1 (1.7 (1.6; 1.9), p<0.005) and Group 2 (1.9 (1.7; 2.1), p<0.05), respectively. Conclusions Utilizing a high-tech auto-call reminder tool in patients with hyperlipidemia and CAD was associated with increased adherence to lipid-lowering therapy, which, in turn, resulted in significant decrease in LDL-C compared to patients who declined to participate in the auto-call program. Funding Acknowledgement Type of funding source: None

Effectiveness of brief schema group therapy for borderline personality disorder symptoms: a randomized pilot study

Background and objectives Schema group therapy is a potentially cost-effective treatment for borderline personality disorder (BPD). We piloted the feasibility and effectiveness of a 20-session schema group therapy without individual therapy among psychiatric BPD outpatients in a randomized pilot study registered as a clinical trial (ISRCTN76381242). Methods Altogether 42 psychiatric outpatients diagnosed with BPD were randomized 2:1 to a 20-session weekly schema group therapy plus treatment as usual (TAU) (n = 28) vs. a control group with TAU alone (n = 14). The primary outcome was decline of BPD symptoms in the short Borderline Symptom List (BSL-23) score. Secondary outcomes were decline in symptoms of anxiety, depression, alcohol use, and improvement in functioning and schema modes. Two external experts evaluated validity of the intervention based on videotaped sessions. Results Overall, 23 schema group therapy patients (82%) and 12 controls (86%) completed their treatment. Treatment validity good or very good. However, no significant differences emerged in the primary outcome mean BSL-23 decline (6.95 [SE 5.91] in group schema therapy vs. 12.55 [4.85] in TAU) or in any of the secondary outcome measures. Limitations Despite randomization, the TAU subgroup had non-significantly higher baseline scores in most measures. Small sample size predisposing to type II errors; reliance on self-reported outcomes. Conclusions Schema group therapy was feasible for psychiatric outpatients with BPD. However, in this small pilot study we did not find it more effective than TAU. Effectiveness of this short intervention remains open.

Group Therapy for Patients With Medical Illness.

This article aims to review the expanding role of group psychotherapy in the treatment of individuals with medical illnesses, an area that has expanded dramatically during the past 30 years. The fundamental principles of adaptation of group therapies for specialized clinical populations are articulated. Clarity of goals and thoughtful alignment with patient interests and needs are at the heart of building a strong therapeutic alliance and potentiate the effectiveness of group therapy. This article also discusses the conceptual underpinnings of group therapies and the ways in which group therapeutic factors gain expression with these clinical populations. This article also focuses on breast cancer, in light of its clinical prominence and the development of group therapies for individuals with the disease. These therapies address clinical concerns for women along the continuum of the disease, including familial and genetic predisposition, primary breast cancer, adaptation to illness and its treatment, metastatic disease, and dealing with mortal illness.

Effects of 12-Week Methylphenidate Treatment on Neurometabolism in Adult Patients with ADHD: The First Double-Blind Placebo-Controlled MR Spectroscopy Study.

Attention deficit hyperactivity disorder (ADHD) is a frequent neurodevelopmental disorder that often persists into adulthood. Methylphenidate (MPH) is the first-line treatment for ADHD; however, despite its wide usage, little is known about its neurometabolic effects. Until now, no randomized and blinded clinical trials have been conducted addressing the neurometabolic signals of MPH administration in adults with ADHD. In the current study, the authors investigated how MPH intake and group psychotherapy (GPT) influence brain neurometabolism over the course of three months. The authors hypothesized a decrease in the anterior cingulate cortex (ACC) glutamate concentration following MPH administration. This study was part of a double-blind multicenter trial (Comparison of Methylphenidate and Psychotherapy in Adult ADHD Study (COMPAS)) investigating the effects of MPH and GPT in patients with adult ADHD. Using single-voxel magnetic resonance spectroscopy (MRS) of the pregenual ACC and the left cerebellar hemisphere (CHL), we investigated the concentration of glutamate plus glutamine (Glx), N-acetyl-aspartate, creatine, total choline containing compounds, and myo-inositol in patients before and after 12 weeks of treatment. Neither MPH nor GPT significantly influenced the Glx concentration or any of the other metabolite concentrations in the ACC and CHL after 12 weeks. Therefore, contrary to the hypothesis, no change in the prefrontal Glx signal was detected after MPH treatment. Given that MRS does not differentiate between glutamate in the synaptic cleft and in neuronal tissue, MPH-induced down-regulation of glutamatergic neurotransmission in the ACC might only affect the concentration of glutamate in the synaptic cleft, while the general availability of glutamate in the respective neuronal tissue might be unaffected by MPH intake. The observed lack of any MPH-induced normalization in metabolite concentrations is less surprising, considering that the baseline sample did not significantly differ from a healthy control group. Future studies of other regions, such as the basal ganglia, and the use of novel methods, such as whole brain MRS and multimodal imaging approaches, are necessary.

Lived experiences of psychiatric patients with mood disorders who attended group therapy facilitated by professional psychiatric nurses.

BackgroundAccording to the World Health Organization (WHO), up to 25% of people worldwide will develop mental health disorders during their lifetime. Patients admitted to acute inpatient units for mood disorders experience emotional distress. Group therapy has the potential to foster the therapeutic change through specific therapeutic mechanisms. Psychiatric nurses working in inpatient units are in a unique position to offer group therapy.ObjectivesExplore and describe stabilised acute psychiatric patients with mood disorders’ lived experiences of group therapy facilitated by psychiatric nurses. Make specific recommendations for psychiatric nurses to facilitate constructive group therapy for stabilised acute psychiatric patients with mood disorders in an inpatient unit.MethodA qualitative, exploratory, descriptive and contextual design was used in the study. A purposive sample of all patients with mood disorders older than 18 years admitted to inpatient units who participated in group therapy was made. Data were collected through conducting phenomenological interviews, observation and field notes. Interviews focussed on the following open question: ‘How did you experience group therapy facilitated by the psychiatric nurses?’ An independent coder analysed the data by using thematic coding. Measures to ensure trustworthiness were applied. The following four ethical principles were adhered to: autonomy, non-maleficence, beneficence and justice.ResultsThree themes emerged from this study. Theme 1 entailed the psychological experiences of patients attending group therapy. Theme 2 highlighted the interpersonal experiences of patients. Theme 3 evolved around patients’ experiences outside group therapy. Patients initially experienced attending group therapy as anxiety provoking. However, negative psychological experiences soon transformed into positive psychological experiences.ConclusionThe findings of this study were used to make specific recommendations to facilitate constructive group therapy for patients with mood disorders.

Efficacy of cognitive-behavioral group therapy in patients at risk for serious mental illness presenting with subthreshold bipolar symptoms: Results from a prespecified interim analysis of a multicenter, randomized, controlled study.

Most patients with bipolar disorders (BD) exhibit prodromal symptoms before a first (hypo)manic episode. Patients with clinically significant symptoms fulfilling at-risk criteria for serious mental illness (SMI) require effective and safe treatment. Cognitive-behavioral psychotherapy (CBT) has shown promising results in early stages of BD and in patients at high risk for psychosis. We aimed to investigate whether group CBT can improve symptoms and functional deficits in young patients at risk for SMI presenting with subthreshold bipolar symptoms. In a multicenter, randomized, controlled trial, patients at clinical risk for SMI presenting with subthreshold bipolar symptoms aged 15-30years were randomized to 14weeks of at-risk for BD-specific group CBT or unstructured group meetings. Primary efficacy endpoints were differences in affective symptomatology and psychosocial functioning at 14weeks. At-risk status was defined as a combination of subthreshold bipolar symptomatology, reduction of psychosocial functioning and a family history for (schizo)affective disorders. A prespecified interim analysis was conducted at 75% of the targeted sample. Of 128 screened participants, 75 were randomized to group CBT (n=38, completers=65.8%) vs unstructured group meetings (n=37, completers=78.4%). Affective symptomatology and psychosocial functioning improved significantly at week 14 (P<.001) and during 6months (P<.001) in both groups, without significant between-group differences. Findings are limited by the interim character of the analysis, the use of not fully validated early detection interviews, a newly adapted intervention manual, and the substantial drop-outs. Results suggest that young patients at-risk for SMI presenting with subthreshold bipolar symptoms benefit from early group sessions. The degree of specificity and psychotherapeutic interaction needed requires clarification.

Take me back to move me forward: Re-enactment of the family system as a pathway to better quality of life for alexithymic patients in group therapy.

Despite much attention in the clinical literature, research on alexithymia in the treatment setting has only recently gained traction. While several reports indicate limited benefit from therapy amongst patients with high alexithymia, this seems to be less so in the context of group therapy. This study considers a specific aspect of the group therapy process - family re-enactment - in facilitating improvement in overall quality of life for patients with high levels of alexithymia. Family re-enactment was examined as a potential mediator of the relationship between alexithymia and change in quality of life among 50 patients who completed treatment in an intensive, integrative group therapy programme. Patients completed three self-report measures: Toronto Alexithymia Scale-20 (baseline), Quality of Life Inventory (baseline, post-therapy), and Therapeutic Factors Inventory-Short Form (week 8). Regression with mediation analysis was employed using the change score for the QOLI as the dependent variable, alexithymia scores as the independent variable, and the family re-enactment score as the mediator; baseline quality of life was included in the model as a control variable. Family re-enactment emerged as a significant mediator of the relationship between alexithymia and treatment outcome, implicating it as a contributing mechanism of change for alexithymic patients who participate in group therapy. Patients with higher levels of alexithymia (in particular, difficulty identifying and describing feelings) were more likely to positively endorse aspects of family re-enactment during group therapy, which in turn were significantly associated with greater improvement in patients' overall quality of life.

New Directions in Gestalt Group Therapy: Relational Ground, Authentic Self

New Directions in Gestalt Group Therapy: Relational Ground, Authentic Self

Effectiveness and Safety/Tolerability of Eslicarbazepine Acetate in Epilepsy Patients Aged ≥ 60 Versus < 60Years: A Subanalysis from the Euro-Esli Study.

IntroductionClinical practice studies help guide antiepileptic drug (AED) therapy in patient groups routinely excluded from clinical trials, such as the elderly. The Euro-Esli study investigated the effectiveness and safety/tolerability of eslicarbazepine acetate (ESL) when used in everyday clinical practice in Europe. A subanalysis of data from elderly patients (≥ 60 years) included in the Euro-Esli study was conducted to assess these aspects of ESL use in this population.MethodsEuro-Esli was a pooled analysis of 14 European clinical practice studies. Effectiveness parameters included responder (≥ 50% seizure frequency reduction) and seizure freedom rates after 3, 6 and 12 months of treatment and at last visit. Safety and tolerability were assessed throughout the follow-up by evaluating adverse events (AEs) and ESL discontinuation due to AEs, respectively. Data were compared for patients aged ≥ 60 versus those aged < 60 years at study entry.ResultsEuro-Esli included 2058 patients (mean age 44.0 years). Age at study entry was known for 2057 patients, of whom 358 (17.4%) and 1699 (82.6%) were aged ≥ 60 and < 60 years, respectively. Mean maximum ESL dose was 882.0 and 1008.2 mg/day in patients aged ≥ 60 and < 60 years, respectively (p < 0.001). At all timepoints, responder and seizure freedom rates were significantly higher in patients aged ≥ 60 versus < 60 years; for example, at 12 months, responder rates were 83.9 and 73.7%, respectively (p = 0.002), and seizure freedom rates were 58.5 and 37.1%, respectively (p < 0.001). The incidence of AEs was significantly higher in patients aged ≥ 60 versus < 60 years (41.4 vs. 32.5%; p = 0.001), but the rate of discontinuation due to AEs was comparable between age groups (16.2 vs 13.1%; p = not significant). The safety/tolerability of ESL in patients aged ≥ 60 years was consistent with its known profile.ConclusionEslicarbazepine acetate was efficacious and generally well tolerated when used to treat elderly patients with focal epilepsy in clinical practice, with no new or unexpected safety signals emerging in this setting.FundingEisai Ltd.

Group Voice Therapy Reduces Anxiety in Patients With Dysphonia

To evaluate the impact of group therapy in patients with dysphonia, as well as to verify the correlation between vocal symptoms and levels of anxiety. The study was composed of 52 patients subdivided into two groups, named the Experimental Group (EG) with 28 volunteers and the Control Group (CG) with 24 volunteers. Anxiety and voice protocols were used for data collection. The State-Trait Anxiety Inventory (STAI) was used to measure trait levels of anxiety that after collection were categorized according to the variation in scores value: low anxiety (20-40 points); average anxiety (40-60 points); high anxiety (60-80 points). In addition, the Voice Symptom Scale (VoiSS) was used for voice assessment. Inferential statistical analysis from the Student's t test for paired and independent data, in order to compare the average scores of STAI trait levels and VoiSS domains of the pre- and postmoments, intra- and intergroups, EG and CG, respectively. For that purpose, the program Statistical Package for Social Sciences (SPSS) was used. Half of the patients in the survey presented an average trait level of anxiety. Regarding the EG, there was a significant reduction of state anxiety when comparing the moments before and after group therapy. There was also a significant reduction in the values of the VoiSS-Total and VoiSS-Physical domains when compared to the pre- and postgroup therapy moments. It was verified the existence of a positive correlation between the levels of anxiety after group therapy and VoiSS-Total, VoiSS-Limitation, and VoiSS-Physical domains. As for the CG, there was an increase in anxiety levels as well as in all domains of the VoiSS scale when compared to the pre- and postmoments. Group voice therapy was effective for a significant reduction of vocal symptoms and anxiety - common conditions in patients with dysphonia. It was possible to perceive the positive correlation between anxiety levels and vocal symptoms.

Acute Respiratory Tract Infections/Acute Bronchitis

Was ist neu? Stand der Dinge Die akute Bronchitis ist eine selbstlimitierende, akute Entzündung der Atemwege und tritt meistens im Rahmen einer viral bedingten Erkältung in Erscheinung. Obwohl sie in der Regel nach zwei bis drei Wochen selbstlimitierend abklingt, sind viele Patienten ungeduldig und fordern mitunter eine Antibiotikabehandlung. Diagnostik Anamnese und körperliche Untersuchung sind bei unkomplizierter akuter Bronchitis ausreichend. Bei älteren, multimorbiden oder immunsupprimierten Patienten oder Auffälligkeiten bei Vitalparametern ist eine weitergehende Differenzialdiagnostik notwendig. Die Bestimmung des Procalcitonins konnte in prospektiven Studien bisher keinen sicheren Nutzen zeigen. Therapie Bei der unkomplizierten akuten Bronchitis erfolgt eine symptomatische Therapie. Um Fehlverschreibungen zu verhindern, sind die Edukation von Arzt und Patient sowie eine Verschreibung erst bei Zweitkontakt erfolgreich. Die antibiotische Therapie bleibt einem Risikokollektiv vorbehalten. Es bleibt abzuwarten, ob mittels Procalcitonin in Zukunft Patienten bestimmt werden können, bei denen auf eine antibiotische Therapie verzichtet werden kann.

Differentiated approach to the use of optimal medical therapy in patients with various clinical forms of stable ischemic heart disease

A total of 137 male patients with stable ischemic heart disease (SIHD), average age 62.3 ± 7.46 years, were divided into 3 groups depending on the initial measurements of blood pressure (BP) and heart rate (HR). Group 1 included patients with elevated blood pressure and/or heart rate (44.5% of patients); Group 2 included patients with normal blood pressure and/or heart rate (38.7%); Group 3 included patients with lowered blood pressure and/or heart rate (16.8%). Patients of Group 1 received beta-adrenergic blockers (BABs) or non-dihydropyridine calcium channel blockers (NDCCBs), in some cases ivabradine-containing BABs (Raenom®, Gedeon Richter) at doses required to achieve target blood pressure and heart rate. The patients of Group 2 received a limited range of drugs above listed due to their blood pressure and heart rate measurements, and the patients of Group 3 did not receive any due to the low levels of such measurements. Effectiveness of the therapy in patients of Group I was the highest. The use of trimetazidine MB (Predizin MB®, Gedeon Richter) has significantly improved the results of treatment in patients of Groups 2 and 3. Trimetazidine MB added to the therapy in patients of Group 1 improved the effectiveness of treatment. Prolongation of trimetazidine MB therapy contributed to improvement of its anti-ischemic effect. Thus, BABs, NDCCBs and ivabradine entered into the foreground, as an optimal medical therapy (OMT) in patients with elevated blood pressure and heart rate measurements. Trimetazidine MB, and ivabradine in some cases prevail in patients with normal and low blood pressure and/or heart rate. It should be stated that patients with various hemodynamic variants of SIHDa require a differentiated approach to the choice of OMT.

Personalized approach to the treatment of depression in the elderly

To develop a personalized approach to the appointment of a complex antidepressant therapy in combination with drugs of neuroprotective and neurotrophic action in depressed elderly patients based on the selection of predictors of low therapeutic response (LTR). The study included 152 hospitalized patients, aged 60 years and older, with moderate and mild depression (ICD-10) who received monotherapy (44 people) with antidepressants of the new generation and complex therapy (108 people) with the same antidepressants in combination with neuroprotective drugs. In the monotherapy group, correlations between treatment efficacy (change in average total HAMD-17 scores) and a set of parameters, including socio-demographic data, results of psychopathological, somatic, standardized assessment and neuroimaging (CT) of the brain were analyzed. The validity of the established correlations as predictors of LTR was estimated based on a comparison of their frequency among the responders (≥50% reduction) and non-responders (<50% reduction). Comparison of the efficacy of therapy in groups of patients with mono - and complex therapy was carried out depending on the presence or absence of predictors of LTR. LTR predictors are living alone, complaints about memory loss and signs of pronounced diffuse lesions of the subcortical white matter of the brain, which are significantly more frequently observed in non-responders (p<0.05). The increase in the number of predictors (2 and more) correlates with a significant decrease in therapeutic efficacy (p<0.001). Patients with complex in structure and protracted depressions tend to decrease in efficiency, and in most of them (more than 87% of cases) LTR predictors are detected. In patients with LTR predictors, the complex therapy is significantly more effective than monotherapy, allowing in all cases to achieve 50% reduction of depressive symptoms by the 4th week of treatment. Personalized indications for the appointment of complex antidepressant therapy in combination with neuroprotective drugs in depressed elderly patients are formulated.

Five-sessions of cognitive behavioral group therapy in patients with panic disorder: a preliminary study

Background: The present study was designed to examine the relationship between panic severity and symptomatic outcome following brief cognitive-behavioral group therapy (CBGT). Method: The sample consisted of 15 outpatients suffering from Panic Disorder who underwent CBGT. Panic severity was assessed by the Panic Disorder Severity Scale (PDSS), and Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Body Sensations Questionnaire (BSQ), Agoraphobic Cognitions Questionnaire (ACQ) and Health Anxiety Inventory (HAI) were administered to the patients by the study team at baseline, after the second and 5th session,post-treatment and first month. Results: At the end of 5 sessions, a significant decrease was observed in the severity of panic disorder, depression and anxiety values, body sensations and health anxiety levels and this decrease was maintained at 1 month. Conclusions: According to our results, our 5-session protocol seems to be a fast and effective option in the treatment of panic disorder.

Proliferative features of diffuse astrocytic tumors Grade III-IV and their impact on the prognosis

Anaplastic astrocytoma and glioblastoma are malignant brain tumors with a poor prognosis. The aim of our study was the complex investigation of the factors, those influence their aggressive behavior and proliferation (Ki-67, EGFR, MMP-9, PR, р53, vascular network formation), and the evaluation of their prognostic impact. These data could be used for optimization of target therapy in different groups of patients with diffuse astrocytic tumors Grade III-IV. Our study included 30 patients who were put through brain surgery for the first time and were divided into two equal groups: 15 patients who experienced a recurrence within 1 year after the surgery (1st group) and 15 patients without recurrence within 1 year after the surgery (2nd group). Postoperative tumor materials were obtained in formalin-fixed, paraffin-embedded blocks. In addition, we investigated the case histories of these patients. The expression of Ki-67, EGFR, MMP-9, PR, р53, VEGF, and CD34 was evaluated with immunohistochemical testing. Chi-squared test, Mann-Whitney U and Kruskal-Wallis H tests were performed for comparison of quantitative parameters between groups. Spearman’s rank correlation coefficient was used for the measure of rank correlation between quantitative variables. Results of our study showed, that there was a tendency (Uemp=75,00; р&gt;0.05) to higher proliferative index in the 1st group (18,29±3,44) compared to the 2nd group (16,57±3,09). EGFR expression was significantly higher in the 1st group (Uemp=70.50; p&lt;0.05). Moreover, the higher EGFR expression was associated with higher MMP-9 expression (Uemp=7.500; p&lt;0.01) and lower p53 expression (rs= –0.62, p&lt;0.001). The higher MMP-9 expression was also associated with higher vascularization index (MVD(VEGF)/MVD(CD34)) (rs=0.43; p&lt;0.05). Our data confirm the close connections of different factors of tumor aggressiveness and the presence of molecule-biological discrepancy in homogenous histologically, but heterogenous prognostically groups of tumors. This evidence may be used in future for better-personalized therapy of patients with diffuse astrocytic tumors Grade III-IV.

THE LONG-TIME EFFECTS OF GROUP THERAPY INTERVENTION ON MARRIAGE COMMUNICATION BETWEEN FLUENT AND NON-FLUENT APHASIC PATIENTS AND THEIR SPOUSES: WHO BENEFITS THE MOST?

Our study aims to assess the long-time effects of group therapy intervention on marriage communication between fluent and non-fluent aphasic patients and their spouses. From the initial cohort of 150 couples four experimental groups have been selected, each comprising 20 subjects: (1) patients with fluent aphasia (FAP) (2) patients with fluent aphasia spouses (FAPS) (3) patients with non-fluent aphasia (NFAP) (4) patients with non-fluent aphasia spouses (NFAPS). All aphasic patients had mild or moderate fluent or nonfluent aphasia, as confirmed by the Cracow Neuropsychological Battery for Aphasia Examination – CNBA (Pąchalska, 1999). To assess the 3 aspects of interactions between spouses: support, engagement and depreciation we use the Communication in Marriage Questionnaire – KKM scores (Kaźmierczak, Plopa, 2008). These patients attended the groups sessions administered according to Pąchalska’s Model of Aphasia Group Therapy (1991a; 1991b) . It was found that after the long-time group intervention the experimental and the control groups of aphasic patients as well as their spouses differ one from another. NFAP as well as FAP therapy patients had higher KKM scores in the support received from their spouses and their spouses engagement in communication and lower scores in depreciation in their spouses’ behavior than did the controls. Also NFAPS evaluated support and engagement expressed by their aphasic partner higher than the control group. However FAPS and the control group KKM scores were quite similar, except for the support expressed by their aphasic partner. Long-time group therapy for patients with aphasia with the presence of caregivers not only improves the communication with significant others but also it is associated with better marital interactions and communication after therapy as reflected in the KKM scores than in the case of the controls, and improves the patient’s and caregivers’ perception of quality of life.

Quality of life and sexual health in men with prostate cancer undergoing radical prostatectomy

The aim of this study was to evaluate the relationship between quality of life, erectile function and group psychotherapy in patients with prostate cancer undergoing radical prostatectomy. Sixty patients were evaluated for erectile function (IIEF-5), quality of life (SF-36SF), urinary incontinence (ICQI-SF and ICQI-OAB). Thirty of them had group psychotherapy two weeks before and 12 weeks after surgery. Patients who underwent group psychotherapy had better scores in IIEF-5, satisfaction with life in general, satisfaction with sexual life and in partner relationship; better results of SF-36SF, excepting two domains: bodily pain and role emotional. There were significant correlations between IIEF-5 and perception of discomfort (p = .030), physical functioning (p = .021), physical component (p = .005) and role emotional (p = .009) in patients undergoing group psychotherapy. In patients who didn't have group psychotherapy there were significant correlations between ICQI-OAB and perception of discomfort (p = .025), social functioning (p = .052) and role emotional (p = .034); between ICQI-SF and perception of discomfort (p = .0001). Group psychotherapy has a positive impact in quality of life and erectile function. There was no difference in the urinary function of the two groups. Further studies are necessary to identify the impact of self-perception and self-knowledge in the postoperative management of radical prostatectomy.

The effects of relationship and progress feedback in group psychotherapy using the Group Questionnaire and Outcome Questionnaire-45: A randomized clinical trial.

Routine outcome monitoring (ROM) systems that identify clients at-risk for treatment failure using outcome and therapeutic process measures are a recognized evidence-based practice. However, only 3 empirical studies have tested ROMs in group therapy, producing mixed results. This randomized clinical trial tested the Outcome Questionnaire System, the ROM system with the most empirical support for individual therapy patients, with 430 group therapy patients who were randomly assigned to 2 experimental arms (Group Questionnaire [GQ] + Outcome Questionnaire-45 [OQ-45] vs. OQ-45). Given the strong evidence for progress feedback, the primary purpose of this study was to ascertain if therapeutic relationship feedback using the GQ reduced rates of relationship deterioration and failure when progress feedback was held constant. Group leaders simultaneously ran pairs of groups that were randomly assigned to the 2 conditions. Of the 430 patients enrolled in 58 groups, 374 attended more than 4 sessions. Results showed that therapeutic relationship predicted improvement in outcome and that feedback reversed the course of relationship deterioration and reduced rates of relationship failure. Although there were no effects on attendance and dropout for feedback, the 2 experimental arms produced mixed results for the OQ-45 not-on-track cases. The combined relationship and progress feedback (GQ/OQ-45) was associated with fewer outcome deterioration cases, while the progress feedback condition (OQ-45) showed higher outcome improvement cases. Findings are discussed with respect to previous group ROM studies, clinical implications, and future research. (PsycINFO Database Record

Changes in ego strength in patients with neurotic and personality disorders treated with a short-term comprehensive psychodynamic psychotherapy.

Analysis of changes in ego strength in the course of group psychotherapy in patients treated with neurotic and selected personality disorders (F40-F61, ICD-10). 82 patients (61 women and 21 men) participated in the study. They underwent intensive short-term group psychotherapy treatment in a day hospital for neurotic and behavioural disorders. The assessment of the patients' personality functioning was carried out at the onset and the end of the psychotherapy. The assessment was reported as a value on the ego strength scale by means of the MMPI-2 questionnaire. The comparative analysis with the use of the t-Student test for related measurements, which was carried out for the measurement of ego strength values at the onset and the end of the therapy, demonstrated a statistically significant positive change both for the entire examined group and the groups which considered the gender and diagnosis distribution. Short-term intensive comprehensive group psychotherapy with elements of individual psychotherapy results in obtaining the desired changes in the personality functioning manifested through the increase in ego strength.