Poor Outcome Cases Research Articles

来院時に比べ転帰の悪化した破裂動脈瘤症例の検討

The overall results of 217 patients with subarachnoid hemorrhage (SAH) for the past three years and 33 poor outcome patients in comparison with the grade on admission were analyzed. The sites of aneurysm in poor outcome cases were ICPC in 12 cases (36.4%), Acom in 6 cases (18.2%), MCA in 5 cases (15.2%), BAtip in 5 cases (15.2%), and others in 3 cases (9.1%). The causes of poor outcome cases were vasospasm in 11 cases (33.3%) intraoperative complication in 8 cases (24.3%), preoperative rebleeding in 6 cases (18.2%), and complication in 5 cases (15.1%).Although cisternal irrigations were performed in 9 cases in the vasospasm cases, they were not effective. The causes of intraoperative complications were perforating artery injury in 5 cases (62.5%), premature rupture, incomplete clipping, and embolization from aneurysm in 1 case (12.5%). The preoperative rebleeding rate was 31.2% in Grade 5, 27.8% in Grade 4, 10.0% in Grade 3, 11.2% in Grade 2, and 0% in Grade 1. Considering these analyses of overall management results and poor outcome cases, we suggest the following to improve the SAH outcome: 1) the development of essential therapy for the severe vasospasm; 2) the preservation of perforating artery in the operation; 3) the careful management for the rebleeding in risky period.

Assessment and managem ent of eating disordered patients who over-exercise: A four-year follow-up of six single case studies

The relationship between excessive exercise and eating disorder, both in terms of aetiology and maintenance, has been widely discussed in the extant literature but there are no treatment guidelines. The utility of a specific cognitive-behavioural treatment that included exposure with response prevention, targeted at excessive exercise, was examined in six patients with anorexia nervosa. The pooled outcome data, including four-year follow-up data, from a series of single case studies is presented. The findings suggest that the treatment programme was successful in some cases. A comparison of satisfactory and poor outcome cases indicates a need to evaluate this adjunctive treatment with a larger (controlled) patient sample to assess more accurately its potential additional (relapse prevention) benefit.

Selected cases of poor outcome following a minor brain trauma: comparing neuropsychological and positron emission tomography assessment.

Neuropsychological residua are common particularly in the early stages following a minor traumatic brain injury (TBI), however, a minority of individuals complain of persistent deficits following months or years post-accident. Nine such cases are presented with little or no evidence of brain damage demonstrated according to non-functional neuroimaging (for example CT, MRI), yet their neuropsychological examinations were positive. Since the introduction of positron emission tomography (PET), which captures a functional approach, the question arose as to what extent the two techniques (i.e. PET and neuropsychological examination) are interrelated. All nine minor TBI cases revealed a corroboration between the positive neuropsychological findings confirmed on the PET. The PET procedure documented neuropathology which frequently was pronounced in the frontal and anteriotemporo-frontal regions. Moreover, no significant differences were evident between those five cases with reported loss of consciousness vs. those four cases without.

The Association Between Complex Types of Therapist Interventions and Outcomes in Psychodynamic Psychotherapy

The association between complex types of therapist interventions and psychotherapy outcome was investigated by comparing five individual therapy cases with good outcomes to four with poor outcomes. Therapist behaviors in the third session of 20 sessions of psychodynamic psychotherapy were analyzed by four different rating systems. These ratings were used individually and in combination to investigate group differences between good- and poor-outcome cases. Results demonstrated that therapists in the poor-outcome cases exhibited significantly more disaffiliative communications and significantly more disaffiliative interpretive communications that did not focus on the therapist-client relationship or client affect. Additionally, results indicated that interpretive communications and communications that focused on the therapist- client relationship were most prone to being used in a disaffiliative manner. Implications for social work practice and further research are discussed.

Obsessive-compulsive symptoms in eating disorders

Obsessive-compulsive symptoms were measured in a consecutive series of new referrals with anorexia nervosa ( n = 29) and bulimia nervosa ( n = 77). In contrast with previous reports, there was no significant difference on MOCI scores between eating disorder groups and normal controls. A consecutive series of 38 patients with bulimia nervosa then entered a structured treatment programme. Poor outcome cases had a higher score on the MOCI-doubting sub-scale. However, there was no significant difference in obsessive-compulsive scores between those who were binge-free and those who were bingeing daily at the end of treatment and there was no significant in outcome between high and low-scorers on the MOCI. This study fails to support the view that the eating disorders are a subtype of OCD. Previous conflicting results are attributed to selection bias and the effects of low body weight.

Patient and therapist introject, interpersonal process, and differential psychotherapy outcome.

The Structural Analysis of Social Behavior (SASB; Benjamin, 1974, 1982, 1984) system was used to study the interpersonal process between patient and therapist in the 3rd session of 14 therapeutic dyads. Dyads were grouped into good and poor outcomes cases (n = 7) on the basis of the amount of change in the patients' introject as measured by the INTREX Introject Questionnaire (Benjamin, 1983). Strong support was found for the following hypotheses based on interpersonal theory, linking therapists' introject state, interpersonal process in therapy, and outcome: (a) Poor outcome cases (no introject change) were typified by interpersonal behaviors by the therapist that confirmed a negative patient introject; (b) the number of therapists' statements that were subtly hostile and controlling was highly correlated with the number of self-blaming statements by the patients; (c) therapists with disaffiliative introjects tended to engage in a much higher level of problematic interpersonal processes that have been associated with poor outcome. Implications for future research and therapist training are discussed.

Patient and therapist introject, interpersonal process, and differential psychotherapy outcome.

The Structural Analysis of Social Behavior (SASB; Benjamin, 1974, 1982, 1984) system was used to study the interpersonal process between patient and therapist in the 3rd session of 14 therapeutic dyads. Dyads were grouped into good and poor outcomes cases (n = 7) on the basis of the amount of change in the patients' introject as measured by the INTREX Introject Questionnaire (Benjamin, 1983). Strong support was found for the following hypotheses based on interpersonal theory, linking therapists' introject state, interpersonal process in therapy, and outcome: (a) Poor outcome cases (no introject change) were typified by interpersonal behaviors by the therapist that confirmed a negative patient introject; (b) the number of therapists' statements that were subtly hostile and controlling was highly correlated with the number of self-blaming statements by the patients; (c) therapists with disaffiliative introjects tended to engage in a much higher level of problematic interpersonal processes that have been associated with poor outcome. Implications for future research and therapist training are discussed.

Increased Severity of Fetal Hemolytic Disease with Known Rhesus Alloimmunization after First-Trimester Transcervical Chorionic Villus Biopsy

Fetomaternal hemorrhage secondary to chorionic villus biopsy has the potential to accelerate fetal hemolytic disease in the pregnant patient previously sensitized to red cell antigens. A case of poor fetal outcome after first-trimester transcervical chorionic villus sampling in an alloimmunized patient is reported. An increase in antibody titers was associated with the demise of a hydropic fetus early in the second trimester. Maternal red cell alloimmunization is suggested as an absolute contraindication for chorionic villus sampling performed for genetic indications.

The relationship between schizophrenic patients' perceptions of their parents and the course of their illness.

Sixty-two schizophrenic patients completed the Parental Bonding Instrument (PBI), a measure of perceived parental characteristics, rating their parents on care and protection. PBI ratings were related to a one-year course of illness. Patients who perceived their parents positively tended to experience a milder course of illness if they were in frequent contact with them, and a more severe course if they were not; the reverse was true for patients who perceived their parents negatively. PBI ratings were unrelated to the age at onset of illness. This suggests that patients' perceptions of parental attitudes influence the course of schizophrenia by a current stress effect. The PBI, used alone or in conjunction with other predictors, distinguished good- and poor-outcome cases and appears to be a potentially clinically valuable tool.

Structural analysis of social behavior: application to a study of interpersonal process in differential psychotherapeutic outcome.

Research strategies employing Structural Analysis of Social Behavior (SASB) were demonstrated in a study comparing 4 therapists, each of whom saw a good and a poor outcome case (N = 8), on interpersonal process variables in the third session. SASB represents complex interactive processes in a manner that is both theoretically cogent and empirically sound. Good versus poor therapeutic outcome was differentiated on the basis of the following interpersonal process variables: greater levels of helping and protecting and affirming and understanding*' and significantly lower levels of blaming and belittling were associated with high-change cases. Patient behaviors of disclosing and expressing were significantly more frequent in high-change cases, whereas walling off and avoiding and trusting and relying were significantly more frequent in low-change cases. Additionally, negative complementarity was greater in poor outcome cases. Implications for research methodology and interpersonal theory are discussed.