Psychoeducation Therapy Research Articles

EFEKTIFITAS PEMBERIAN FAMILY PSYCHOEDUCATION (FPE) TERHADAP KEPATUHAN MINUM OBAT PENDERITA SKIZOFRENIA DI KOTA KEDIRI

ABSTRACT THE EFFECTIVENESS OF FAMILY PSYCHOEDUCATION (FPE) ON DRUG SUBSTITUTION OF SKIZOFRENIA PATIENTS IN THE CITY OF KEDIRI Dhita Kurnia Sari 1, Lingga Kusuma Wardani 2 STIKes Surya Mitra Husada Kediri deeniasari88@gmail.com
 Schizophrenia is one type of psychotic disorders that often experience relapse. About 33% of people with schizophrenia experience recurrence and about 12.1% re-experienced hospitalization. Discontinuation of drugs is a major cause of recurrence of schizophrenic patients. The family of schizophrenic patients is a very important variable in the recurrence of schizophrenic patients. Allegedly the biggest factor in its effect on adherence to taking the drug of schizophrenia is family factor. The purpose of this study is to determine the effectiveness of family psychoeducation therapy on adherence to taking the drug of schizophrenia patients. The design used in this research is pre-experiment. The population in the study were all families of schizophrenic patients in Kediri. Sampling technique in this research is taken by Purposive Sampling. The independent variable is the provision of family psychoeducatin therapy and the dependent variable in this study is the adherence to taking the drug of schizophrenic patients. Data were collected by observation sheet, then analyzed using Mc Nemar test with significance level a£ 0,05. The results of the study of adherence to the treatment of schizophrenic patients before given the family psychoeducation of 20 respondents who did not obey 20 respondents (100%), whereas after given the family psychoeducation obedient 17 (85%) and disobedient 3 (15%), from the results of statistical tests with using Mc Nemar test obtained p value 0,000 <α 0.05 means there is influence of adherence to medication before and after given family psycoeducation. Family knowledge and ability to cope with stressors while caring for family members with schizophrenia can create a comfortable and conducive environment that helps restore the client's condition and reduce and prevent noncompliance with schizophrenia medication.
 Keywords: adherence, family psychoeducation, schizophrenia

Cognitive Behavioral and Family Psychoeducational Therapies for Adolescent Inmates Experiencing Anxiety in a Narcotics Correctional Facility

ABSTRACTIllicit substance use is becoming a major global issue. In Indonesia, inmates imprisoned for illicit substance offences accounted for 40% of the total inmate population. This study aimed to identify the effects of cognitive behavioral and family psychoeducational therapies on inmates’ anxiety in the narcotics correctional facility. Quasi-experimental pre-test–post-test with control group was employed in this study. Intervention Group 1 received a general nursing intervention whereas Intervention Group 2 received a combination of general nursing intervention with cognitive behavioral and family psychoeducational therapies. This study involved 31 inmates for each group. Data were collected using the Hamilton Anxiety Rating Scale (HAM-A) and were analyzed using repeated ANOVA and independent t-tests. The study demonstrated that anxiety was significantly lower among those who received the combination of those three therapies compared to those who received general nursing intervention standalone (p < .005). This study suggested the implementation of both general nursing intervention and specialty therapies, particularly cognitive behavioral and family psychoeducational therapies, to address the anxiety problems experienced by adolescent inmates suffering from illicit substance dependence.

Implementing Collaborative Care for anxiety and depression: a qualitative study from the Capital Region of Denmark

Introduction: Mental health problems constitute a substantial burden for patients and health systems. In order to improve the treatment of patients suffering from anxiety and depression, collaborative care models have been developed. Collaborative care is a complex intervention that involves a systematic cross-sectorial and inter-professional collaboration between primary and secondary care. While positive effects of collaborative care have been found in several trials, fewer studies have focused on implementation issues and most of these have been conducted in the US or the UK. It is important to supplement this knowledge base with implementation research from other health systems. The aim of this study was to identify the various facilitators and challenges to implementing a collaborative care intervention in the Capital Region of Denmark from 2014 to 2017. Methods and theory: In the intervention, eight care managers (CMs) are employed to treat patients (with anxiety or depression) referred by their general practitioner (GP). The CMs – mostly trained psychiatric nurses – provide psychoeducation and cognitive behavioral therapy, and the overall treatment approach is based on principles of stepped-care. Other important components of the intervention include regular conferences between the GP and the CM about the patients, and regular supervision of the CMs and the GPs by mental health specialists. CMs and GPs participated in introductory training courses in summer 2014, and the first patients were included in December 2014. Between December 2015 and December 2016 we carried out qualitative interviews with all CMs, two psychiatrists, and five GPs. A focus group with all care managers was held in February 2017. We also observed information events, training courses, supervision sessions, and meetings between care managers and general practitioners. The analysis is based on Normalization Process Theory. Results: GPs appreciated that collaborative care offered their patients free and easy access to mental health care, and had confidence in the skills of the care managers. However, several GPs did not see the point in receiving regular supervision from a psychiatrist for this particular group of patients, leading to low turn-out at the supervision sessions. The case-based meetings between the GPs and the care managers were generally described as being meaningful and constructive. The care managers were highly motivated, and performed a significant amount of implementation work in order to deal with challenges related to limited opportunities for co-location, logistics, and varying degrees of engagement among the GPs. Discussion and conclusion: Preparing the ground for implementation requires detailed negotiations with representatives from general practice over issues of reimbursement, the location of care managers, and the regular interaction with care managers and psychiatric supervisors. Furthermore, questions of overall leadership and responsibility have to be clarified. Future research could focus on developing and testing extended models of collaborative care which include patients with mental health problems that are more difficult for general practice to handle.

PSYCHOEDUCATION THERAPY REDUCES BURDEN AND IMPROVES FAMILY ABILITY IN CARING FOR MENTAL RETARDATION CHILDREN

Introduction: Children with mental retardation have intellectual functioning below average, inadequate self-care behaviors, socializing, communication, adaptive skills, participation and family support is needed to enhance the independence of the child so that the capability increased and decreased the family burden. Various therapists can be treated to increase the capability of families including family psyche-education therapy. This study is aimed to identify the influence of psycho-education therapy to the family burden and the capability of families in caring for mentally retarded children in SDLB Prof. Dr. Sri Soedewi Masjchun Sofwan, SH Jambi. Method: Quantitative research quasi-experimental, nonequivalent, control group pre-test and post-test design. A sample of 64 respondents consisting of 32 intervention and 32 control with proportional random sampling technique. The data was collected using a structured questionnaire with interview method. Result: The results showed a decrease of the burden and increase the capability of a family in caring for children with mental retardation after psycho-education therapy. Psycho-education therapy is a therapy that can be implemented for a family with psychosocial disorders where exchanged information on mental health care due to the illness suffered, help family members to understand about the disease. Discussion: It is recommended to conduct research that combines psycho-education therapy and supportive therapy to psychosocial support family of children with mental retardation.Keywords: burden, caring capability, mental retardation, psycho-education

Diagnosis and Treatment of Functional (Psychogenic) Parkinsonism.

Functional (psychogenic) parkinsonism (FP) is recognized by the mandatory combination of marked slowness without progressive decrement on repetitive manual tasks and variable resistance against passive movements in the absence of cogwheel rigidity. Other functional phenotypes, such as functional tremor and functional gait impairment, may coexist. Although neither necessary nor sufficient for the diagnosis of FP, supportive historical clues include the sudden onset of symptoms and absent or nonphysiologic response to levodopa. In selected cases where examination features remain insufficient to render a clinically definite FP diagnosis, normal dopaminergic transporter imaging (DAT scan) confirms "laboratory supported" FP. The management of FP begins with diagnostic debriefing, as the full acceptance of the diagnosis is critical in ensuring patient involvement in individualized psychoeducation, psychotherapy, and physical and occupational therapy.

The Grieving Process Experienced Family and Charges in Treating Children with Autism

Introduction: Children with autism will be a stressor to their family. This research aims to describe about family grieving process and family burden when taking care of their children with autism at Special Needs School Bangun Bangsa, Surabaya.Method: This research used descriptive phenomenology design with indepth interview method. The participant of this research was six member of a family who plays role as the main caregiver for autism child. This study employs the purposive sampling method. The data is gathered through interviews and fi eld notes that is then analyzed with the Collaizi technique. This research generated three themes.Result: The results illustrate families display the grieving process as a cycle. They feel a deep, permanent and long period of grief through in to five stages of grief: denial, anger, depression, bargaining and acceptance. The Grieving is come from the caregiver and the autism child. Large amounts of grief cause families in grief for a long period and this causes family burden. There are six family burden, psychological burden, physical burden, financial burden, social burden, time burden and thought burden.Conclusion: Finding of the research would hopefully be beneficial to professional health staff, especially psychiatric nurses to complete their ability in minimizing various negative impacts that the family may suffer from while taking care their autism children with autism through nursing care plans designs development, researches about family empowerment in burden managements and also a research to improve the Family Psycho-education Therapy and a specific Supportive Group Therapy modules for family with autism children.

Psychosocial interventions to improve the quality of life for men with prostate cancer: A network meta-analysis of 31 randomized controlled trials

BackgroundThe treatment of prostate cancer (PCa) can trigger a sequence of life-altering decisions that can induce depression and effects on health-related quality of life. We aimed to simultaneously compare all available psychosocial interventions using both direct and indirect data.MethodsIn this systematic review and network meta-analysis, we searched the Embase, Medline, PsycINFO, and the Cochrane central register of controlled trials for randomized controlled trials (RCT) published before Oct, 2016, that compared active treatments dealing with psychosocial problems in PCa patients after treatment. The primary outcome was health-related quality of life improvement as measured by the 36-Item Short-Form Health Survey (SF-36). Psychological morbidity was assessed with the Hospital Anxiety and Depression Scale (HADS). This study is registered with PROSPERO, number CRD42016049621.ResultsWe screened 113 potentially eligible studies and identified 31 RCTs, that examined 7 psychosocial interventions in 3643 PCa participants. In terms of SF-36, cognitive behavioral therapy [standard mean difference (SMD) 2·48, credible interval [CrI] 0.23 to 4.46], group based counseling (SMD 1·36, CrI 0·40 to 3·17) had significantly greater effects than usual care. Participants assigned to all assessed interventions had a significantly improvement in depression compared with usual care, except for those assigned to psychoeducational therapy (SMD 0.02, 95% CrI -0.11 to 0.15).ConclusionThis review shows that cognitive behavioral therapy, group based counseling and exercise may have significant beneficial effects considering SF-36 and HADS when compared with usual care. However, additional well-done research studies are necessary to establish the role of psychosocial interventions in men with PCa.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Dhat Syndrome: Culture Bound, Separate Entity, or Removed

Dhat syndrome is a culture bound syndrome of the Indian subcontinent, although this has often been debated. Although, it is being researched for more than half a century there is still no clear definition of Dhat syndrome and characterized by excessive preoccupation with loss of “Dhat,” which is generally taken to be representing semen and attribution of physical and psychological symptoms. It is usually seen in young, unmarried, or recently married men of rural background with conservative attitude toward sex, generally belong to low or medium socio-economic status and education level. It can be treated with anxiolytics, antidepressants, as well as psychological interventions such as psycho-education, sex education, counseling, and cognitive behavior therapy. There is long debate regarding the nosological position of the disease and recent call for attention of psychiatrists in the subcontinent to revisit the nosological status of dhat syndrome with an unbiased mind. Further, systematic studies on the phenomenology of Dhat syndrome is needed to clarify it, especially keeping in mind the extent of the problem in the subcontinent and the distress and dysfunction it results in. Key Words: Dhat Syndrome, Cultural Bound Syndrome, Indian Subcontinent, Bangladesh

Empowering Students in the Trauma-Informed Classroom Through Expressive Arts Therapy

Teachers and school staff are noting an increase in disruptive and aggressive behaviour within the classroom and safety within our schools continues to be questioned. Students arriving in the classroom have diverse backgrounds, which include trauma. For students to feel safe within the classroom they must feel a true sense of belonging; understanding their identity within the classroom context will begin to empower each student to create an environment where they belong. Psychoeducational therapy is one approach that is successfully combined with expressive arts therapy and trauma-informed therapy to facilitate empowerment in students. Restoring each student’s identity within the classroom while addressing the underlying cause of disruptive behaviour will promote social healing.Keywords: student empowerment; trauma-informed classroom; expressive arts therapy; trauma

Bénéfice d’un programme d’éducation thérapeutique agréé sur la qualité de vie et le bien-être psychologique de sujets souffrant de schizophrénie

IntroductionIn schizophrenic disorders, supportive psychosocial therapies have been used as adjuncts to pharmacotherapy to help alleviate residual symptoms and to improve social functioning and quality of life. Among these therapies, psychoeducational therapies showed a significant efficacy on improving drug adherence and on reducing relapses. However, according to the French Health Agency, fewer than 10% of psychiatric structures in France offer registered psychoeducation programs. Caregiver apprehension of patients’ depressive reactions to the awareness of the disease could underlie the underuse of psychoeducation therapies. Indeed, the psychoeducation programs’ impact on objective and subjective quality of life is discussed among the literature. In this context, we conducted a retrospective, monocentric, open-labelled and non-controlled pilot study to measure the impact of a registered psychoeducation program on objective and subjective quality of life of patients suffering from schizophrenia. Secondary objectives included measures of the effects on drug observance and awareness of the disease. MethodsWe included stabilized patients over the age of eighteen suffering from schizophrenia. Referent psychiatrics were asked to inform the patient of the diagnosis and to prescribe psychoeducation therapy. From 2011 to 2014, we offered three ambulatory programs, each program including fifteen two-hour group sessions. The groups were opened for three to six patients and managed by two caregivers. Themes discussed during the sessions included: schizophrenic disease, treatments, relationships to family, diet, social issues, toxics, relaxation. Objective and subjective quality of life were evaluated one month before and one month after the program using respectively the global assessment functioning (GAF) and the subjective quality of life (SQoL) scales. The Medical Adherence Rating Scale (MARS) and the French IQ8 scale evaluated respectively drug adherence and awareness of the disease. All patients gave their written consent for the study. Based on medical records and scales, we compared data before and after the program using the Wilcoxon test, adapted for small samples. ResultsFourteen patients, with a mean age of 37.6 years, were included. All patients had a chronic antipsychotic treatment and four benefitted from a bitherapy with a mood stabilizer. The mean length of disease was 15.3 years, with a mean number of 3.4 hospitalizations before inclusion. The participation rate was nearly twelve sessions out of fifteen. Mean GAF score before the program was 48/100. After the program, mean GAF score was significantly increased to 54/100 (P=0.008). As to SQoL score, we found a significant difference of the sub item psychological well-being from 3.2/5 before the program to 3.8/5 after the program (P=0.03). Global SQoL score and other sub items (self-esteem, resilience, and physical well-being) showed a slight but not significant improvement. The sub items family relationships and sentimental life were diminished, non-significantly. Concerning the drug adherence, the mean MARS score was significantly increased from 6.1 to 6.4/8 (P=0.03). Comparison of the insight IQ8 scale showed a slight but non-significant increase. When asked to note the program, patients were globally very satisfied, with a mean rate of 8.6/10. Of fourteen patients, one needed to be hospitalized three years after program. DiscussionThis retrospective study on a small sample of patients suffering from schizophrenic disorder pointed out a significant improvement on drug adherence, objective quality of life and psychological well-being, after an eight-month registered program of psychoeducational therapy. These results are in line with a recent report from the Cochrane group who reported a significant raise of GAF associated with psychoeducational therapies. The literature data for subjective quality of life are more contradictory. Despite the small sample and evaluation means that need to be corrected in further studies, we reproduced the results described in the literature regarding the improvement on drug adherence. However, the stability of these effects should be checked in the medium and long term. ConclusionAdjunctive psychoeducation therapy has a positive impact on reducing relapses in schizophrenia. In this study, we showed a significant benefit on drug adherence, objective quality of life and psychological well-being on a small sample of patients and provide arguments for the development of psychoeducation programs which are currently underrepresented in France. Our results encourage conducting a further prospective multicenter controlled study on a larger sample to clarify the benefit of psychoeducational therapy on objective and subjective quality of life in schizophrenia.

Treatment with the Self-Discovery Camp (SDiC) improves Internet gaming disorder

IntroductionInternet gaming disorder (IGD) is a novel behavioral addiction that influences the physical, mental, and social aspects of health due to excessive Internet gaming. One type of intensive treatment for IGD is the therapeutic residential camp (TRC), which comprises many types of therapies, including psychotherapy, psychoeducational therapy, and cognitive behavioral therapy. The TRC was developed in South Korea and has been administered to many patients with IGD; however, its efficacy in other countries remains unknown. We investigated the efficacy of the Self-Discovery Camp (SDiC), a Japanese version of a TRC, and the correlations between individual characteristics and outcome measures. MethodsWe recruited 10 patients with IGD (all male, mean age=16.2years, diagnosed using the DSM-5) to spend 8 nights and 9days at the SDiC. We measured gaming time as well as self-efficacy (using the Stages of Change Readiness and Treatment Eagerness Scale, a measure of therapeutic motivation and problem recognition). ResultsTotal gaming time was significantly lower 3months after the SDiC. Problem recognition and self-efficacy towards positive change also improved. Furthermore, there was a correlation between age of onset and problem recognition score. ConclusionsOur results demonstrate the effectiveness of the SDiC for IGD, especially regarding gaming time and self-efficacy. Additionally, age of onset may be a useful predictor of IGD prognosis. Further studies with larger sample sizes and control groups, and that target long-term outcomes, are needed to extend our understanding of SDiC efficacy.

Efficacy of a Brief Psychoeducational Intervention for Mothers of Children with Breath-Holding Spells: A Randomized Controlled Pilot Trial

Objective Mothers of individuals with breath-holding spells (BHS) suffer more often from anxiety and experience more stressors in their everyday life. The purpose of this study was to examine the efficacy of psychoeducational intervention in reducing BHS and coping with these spells. Participants and Methods Mothers who have children with BHS were randomly assigned to one of the two groups: an intervention group receiving psychoeducational therapy in addition to the routine follow-up (n = 31) and a control group who did not receive psychoeducation in their routine follow-up (n = 28). The data collected at the beginning of the study and at the end of 3rd and 6th months about the frequency of the spells per month, maternal anxiety, and depression levels and mothers' perceived self-knowledge about coping BHS of both groups were compared. Results Mothers in psychoeducation group, compared with controls, improved significantly on state anxiety, depression, perceived anticipation anxiety level for BHS of their children and self-knowledge about coping with the spells. Conclusion The intervention program had a positive effect on anxiety-depression levels of the mothers and the frequency of BHS among the children. The possible link between emotional and autonomic dysregulation in children with BHS and maternal mental health were discussed.

Illness Perceptions, Psychiatric Manifestations, and Quality of Life in Patients with Inherited Retinal Dystrophies

ABSTRACTPurpose: We aimed to assess psychiatric manifestations, health-related quality of life (HRQoL), and associated illness perceptions in patients with inherited retinal dystrophies (IRD). Methods: In 48 IRD patients, we assessed a wide range of psychological distress symptoms (Symptom Distress Checklist-90-R), depressive symptom severity (PHQ-9), generic HRQoL (WHOQOL-BREF), and Illness Perceptions (B-IPQ). Ninety-six alleged healthy participants matched for age, sex, and education served as healthy controls and 331 patients with rheumatological disorders served as disease controls. Results: IRD patients exhibited elevated symptoms of phobic anxiety (p=0.049) and paranoid ideation (p=0.028) compared to healthy and disease controls and were less satisfied with their general health (p<0.001) compared to disease controls. They shared, however, similar levels on all other aspects of psychiatric manifestations and HRQoL. The majority of patients acknowledged the hereditary and chronic nature of the illness. They also attributed more symptoms to their disease (illness identity) compared to people with rheumatological disorders (p<0.001), and this attribution was associated with paranoid ideation (p<0.05) and phobic anxiety (p<0.001). Conclusions: Broadening our view of the psychological variables which should be assessed in IRD patients may help to better identify those psychological parameters which impair the patients’ well-being and yet may be amenable to treatment. The design of psycho-educational therapies targeting illness representations may have a beneficial effect upon the IRD patients’ psychological distress and HRQoL.

Correctional Nursing Interventions for Incarcerated Persons with Mental Disorders: An Integrative Review

The authors explore the current state-of-the art of correctional nursing by summarizing the types of interventions employed by nurses, across studies, designed to assist this challenging group of patients. This examination of evidence-based interventions implemented and tested by correctional nurses provides a better understanding of their role and function. Correctional health is a nurse driven system, yet a minimal amount is known about the nurses who practice in these environments or about their contributions to the practice of mental health nursing in correctional environments. An integrative review utilizing PRISMA guidelines examined five databases (Medline/PubMed, PsycInfo, PsychArticles, Sage Criminology, and Academic Search) for peer-reviewed articles that fit selected criteria. Of 324 references identified, 16 studies met criteria. Following assessment of strength of evidence, only eight studies offered scientific proof of the effectiveness of nursing interventions. Nursing interventions implemented in correctional settings targeted incarcerated persons with behavioral and psychological symptoms. Interventions included psycho-education, environmental adaptations, and behavior therapies. The centrality of nurses in correctional health care emphasizes the significance of understanding their role and function in this setting. This integrative review revealed that correctional nurses are actively engaged in providing therapeutic, evidence-based interventions in the health care of incarcerated persons. Of interest, seven of the eight studies focused on incarcerated persons with mental health or substance use issues. Nurse led interventions such as CBT, labyrinth walking, and yoga aim to improve coping and adaptation of incarcerated persons.

Dealing with bipolar disorder

The psychoeducational group therapy program for patients diagnosed with bipolar disorder is carried out in the Hospital Vazquez Diaz in Huelva. The objectives of the group therapy are: provide an adequate patient awareness of the disease, improve the drugs adherence, facilitate early detection of new episodes, stress management, avoid the use and abuse of illegal substances, achieve a consistency in their lifestyle, prevent suicidal behavior, increase understanding and coping with the psychosocial consequences of the past and future episodes, improve social activity, cope with the subsyndromal residual symptoms and the following deterioration and increase the welfare and the quality of life. The group consists of patients diagnosed with bipolar disorder I, II and cyclothymia. The psychiatrist has to establish if it is convenient for the patient to attend the group and has to communicate, if it has been detected, lack of knowledge about the disease, distorted beliefs, lack of awareness of the disease, unhealthy habits and poor adherence to the treatment. The group was a closed group consisting of 10 to 12 patients. It was carried by a clinical psychologist with the help of the clinical psychology residents. The psychoeducational program we developed in our hospital consisted in 9 bimonthly sessions of 90minutes. As a result, we can say that the psychoeducation was very useful in improving the course of bipolar patients and in reducing the number of episodes and hospitalizations. Patients who received psychoeducation and pharmacotherapy have suffered significantly fewer relapses. Therefore, there is a prophylactic efficacy of psychoeducation in bipolar disorders.

Promoting stigma coping and empowerment: Results from the multi-center clinical trial STEM

IntroductionThe stigma of mental illness is still a major challenge for psychiatry. For patients, stigma experiences and self-stigma are associated with reduced quality of life and increased vulnerability to a more chronicle illness course. Nevertheless, there is a scarcity of validated therapeutic approaches addressing strategies for coping with stigma.Objectives and aimsA manualized psycho-educational group therapy for stigma coping and empowerment (STEM) should be tested for efficacy in patients with depression and schizophrenia. The study was funded by a research grant of the Federal Ministry of Education and Research.MethodsA cluster-randomized RCT with two arms including 30 mental health care services (psychiatric inpatient services, day-units, and outpatient services, as well as inpatient psychiatric rehabilitation services) was conducted. The intervention consisted of 8 sessions regular psycho-education group therapy and 3 sessions addressing stigma coping and empowerment. Controls received 11 sessions regular psycho-education. Primary outcome variable was quality of life (WHO-QOL). Assessments were conducted directly before and after the intervention, and at 3, 6 and 12 months follow-ups.ResultsA total of 469 patients participated and more than 300 participants (approx. 65%) completed the 12-month follow-up. First results of the analysis will be presented at the conference.ConclusionsSince the statistical analysis is currently in progress, no conclusions concerning the efficacy of the tested therapeutic approach can be done by now. Nevertheless there is a strong need for supporting patients in developing positive stigma coping strategies. STEM is the first therapeutic approach to our knowledge tested for efficacy in a RCT.Disclosure of interestThe author has not supplied his declaration of competing interest.

Using ACT to Treat Psychosomatic Problems in Clinical Practice : A Report on Psychoeducational Therapy through a Vignette

Using ACT to Treat Psychosomatic Problems in Clinical Practice : A Report on Psychoeducational Therapy through a Vignette

Single-Session Alcohol Interventions for Heavy Drinking College Students: A Systematic Review and Meta-Analysis.

The purpose of this study was to conduct a meta-analysis summarizing the effectiveness of brief, single-session interventions to reduce alcohol use among heavy drinking college students. A comprehensive literature search identified 73 studies comparing the effects of single-session brief alcohol intervention with treatment-as-usual or no-treatment control conditions on alcohol use among heavy drinking college students. Random-effects meta-analyses with robust variance estimates were used to synthesize 662 effect sizes, estimating the average overall effect of the interventions and the variability in effects across a range of moderators. An overall mean effect size of ḡ = 0.18, 95% CI [0.12, 0.24] indicated that, on average, single-session brief alcohol interventions significantly reduced alcohol use among heavy drinking college students relative to comparison conditions. There was minimal variability in effects associated with study method and quality, general study characteristics, participant demographics, or outcome measure type. However, studies using motivational enhancement therapy/motivational interviewing (MET/MI) modalities reported larger effects than those using psychoeducational therapy (PET) interventions. Further investigation revealed that studies using MET/ MI and feedback-only interventions, but not those using cognitive-behavioral therapy or PET modalities, reported average effect sizes that differed significantly from zero. There was also evidence that long-term effects were weaker than short-term effects. Single-session brief alcohol interventions show modest effects for reducing alcohol consumption among heavy drinking college students and may be particularly effective when they incorporate MET/MI principles. More research is needed to directly compare intervention modalities, to develop more potent interventions, and to explore the persistence of long-term effects.

Multimodal and combined multimodal-aerobic therapy in breast cancer survivors with cancer-related fatigue.

e20717 Background: Cancer-related fatigue (CRF) and insomnia are major issues in breast cancer survivors (BC). While aerobic training (AT) is the standard therapy in BC with CRF, the effect-size is only minor to moderate. Other evidence-based treatments are cognitive behavioral therapy e.g. sleep education/restriction (SE) or psycho-education (PE) and mindfulness-based therapies. We investigated a 10-week multimodal program (MT) consisting of SE, PE, eurythmy and painting therapy separately or in combination with AT (CT) and compared MT and CT each with AT. Methods: In a comprehensive cohort design study BC with chronic CRF (6-36 months after adjuvant treatment, Fatigue Numerical Scale ≥ 4) were evenly randomized or allocated by patient preference. Primary endpoint was a composite outcome of the Pittsburgh Sleep Quality Index (PSQI) and the Cancer Fatigue Scale (CFS-D) after 10 weeks (T1); a second endpoint included a six months later (T2) follow-up. We tested confirmatively for non-inferiority of MT vs. ...

Childhood Trauma and Conversion Disorder in a 16-Year-Old Boy

To the Editor: In the early 1900s, Pierre Janet observed a relationship between conversion disorder and childhood suggesting that dissociation during trauma could be adaptive.1,2 Case report. Mr A, a 16-year-old white boy, was admitted to the hospital after 2 days of episodes of rhythmic jerking of his right upper extremity and generalized tremulous shivering movements. During these episodes, he was unable to speak but was able to follow simple commands. Pediatric neurologic consultation, including sleep-deprived electroencephalograph, ruled out organic cause for the episodes. On day 2 of the hospitalization, he began to complain of urinary retention, as well as penile and groin anesthesia. He required bladder catheterization with normal urine volumes. Psychiatric consultation was requested due to concerns that he might have conversion disorder. History revealed current treatment of attention-deficit/hyperactivity disorder with atomoxetine 80 mg, a recent diagnosis of posttraumatic stress disorder (PTSD), and mild intellectual disability. Mr A had been placed in foster care 2 months prior to admission due to physical and sexual abuse by his father, which had consisted of his father at times standing on Mr A’s penis and striking his penis with a stick as punishment. On the day his seizure-like episodes started, he had been scheduled to meet with the legal team to bring charges against his father. On interview, Mr A reported frequent thoughts of the abuse and worried that he would never be able to have children due to the trauma to his penis. In light of the neurologic symptoms, including nonepileptic seizures, urinary retention, and numbness of his genitalia, Mr A was diagnosed with conversion disorder(DSM-5 criteria). He was provided psychoeducation and supportive therapy by the psychiatric consultant, and his symptoms resolved later that day. At 9-month follow-up, Mr A was in psychotherapy and free of neurologic symptoms. Lifetime prevalence of conversion disorder ranges from 11 to 500 per 100,000 population.3 Risk factors include low socioeconomic and educational status, low psychological sophistication, and rural settings,3 all features of our patient. A review of nonepileptic seizures found nearly one-third of patients reported childhood sexual abuse.4 To our knowledge, 2 similar cases have been published. One was the case of an 11-year-old boy with urinary retention, erectile dysfunction, and penile anesthesia following circumcision, and another was of a 15-year-old girl who was sexually and physically abused by her father and presented with tremor and urinary retention.5,6 Most conversion symptoms resolve before hospital discharge, but as many as 20%–25% relapse within 1 year,7 and 4%–15% are eventually diagnosed with a neurologic disorder.8,9 It was prescient that Janet1 connected childhood trauma to transient neurologic disruptions, such as conversion symptoms. It is likely that Mr A’s recent discussions of his trauma, and court proceedings against his father, exacerbated his PTSD. Physiologically, it is plausible that overwhelming stress could increase sympathetic nervous system tone, causing transient urinary retention. Also, the “emotional numbing” often described in PTSD sufferers, and those who self-mutilate in the context of past abuse, may involve disturbances of endogenous opiates or mechanisms of auto-anesthesia that have evolved to help endure extreme pain or stress. In our case, the transient genital numbing may be a sort of “somatic flashback” to his body’s attempts to numb the pain of physical assaults on his genitals. Our patient’s prognosis is enhanced by a clearly identifiable stressor, an emotionally supportive foster parent, and initiation of trauma-focused cognitive-behavioral therapy for children with PTSD. We should be aware that conduct disorder presents in a range of different motor and sensory deficits, and that some of these symptoms may be directly related to specific traumatic or extremely stressful experiences. Identifying these connections may expedite diagnosis and treatment.