Specific Psychological Interventions Research Articles

Psychotherapeutic intervention in somatisation disorder: results of a controlled study from India

Somatisation disorder is a chronic condition often associated with poor response to treatment, troublesome symptoms, distress, disability and burden. Psychosocial interventions have an important role to play in treatment. However, there is a lack of controlled studies especially from the non-western world. The present study assessed the efficacy of non-pharmacological interventions in somatisation disorder using a case control design. Fifteen patients each diagnosed as somatisation disorder as per ICD DCR criteria received six sessions of a specific psychological intervention (designed specifically for the study) or a non-specific psychological intervention along with fluoxetine. The subjects were followed up for 8 weeks. Assessments were carried out at 0, 4 and 8 weeks using structured measures. Mean age of the sample was 33 ± 7.11 years. Both the groups suffered moderate level of depression, anxiety and disability, and high neuroticism and subjective distress as measured on different instruments. A significant improvement was observed in both the groups in all the measures following the intervention. The group receiving the specific interventions showed more improvement. The study concludes that both specific as well as non specific psychotherapeutic interventions can bring substantial improvement in patients with somatisation disorder, with more improvement seen with specific psychotherapeutic interventions.

2547 – Prevention and early intervention in postpartum depression risk

Post-partum depression is a significant public health problem. Birth and neonatal outcomes suffer as a result of maternal depression. As such, effectively treating depression is imperative to the overall health of mother and child. Psychopharmacological interventions are effective in alleviating depresses symptoms. However, the evidence of the safety of their use during nursing is inconclusive. Moreover, women themselves express the desire for non-psychopharmacological options when deciding to manage their depression. The efficacy of specific psychological interventions for the prevention and treatment of post-partum depression has been addressed recently by several studies. In 2011, the Mental Health Department of the Italian National Institute of Health (ISS) received a grant from the Ministry of Health to assess, in Italy, the feasibility and efficacy in actual practice of the demonstrably effective approach based on clinical work and research conducted by Milgrom J. at the Infant Clinic of the Parent-Infant Research Institute, Austin & Repatriation Medical Centre, in Melbourne, Australia (Milgrom J, Negri LM, Gemmill AW, McNeil M, Martin PR., 2005). The preliminary results of that assessment will be presented at the congress.

Improving quality of life in patients with chronic kidney disease: influence of acceptance and personality

A low health-related quality of life (HQL) is associated with the evolution of chronic kidney disease (CKD) and mortality in patients in end-stage of the disease. Therefore research on psychological determinants of HQL is emerging. We investigate whether acceptance of the disease contributes to a better physical and mental health-related quality of life (PHQL and MHQL). We also examine the impact of personality characteristics on acceptance, PHQL and MHQL. In this cross-sectional study, patients from an outpatient clinic of nephrology completed self-report questionnaires on quality of life, acceptance and personality characteristics. We performed correlations, regression analyses and a path analysis. Our sample of 99 patients had a mean duration of CKD of 10.81 years and a mean estimated Glomerular Filtration Rate (eGFR) by Modification of Diet in Renal Disease (MDRD)-formula of 34.49 ml/min (SD 21.66). Regression analyses revealed that acceptance had a significant positive contribution to the prediction of PHQL and MHQL. Neuroticism was negatively associated with acceptance and MHQL. Path analysis showed that 37% of the total effect of neuroticism on MHQL was mediated by acceptance. Acceptance is an important positive variable in accounting for HQL, however, clinicians must be aware that if patients have a high level of neuroticism they are likely to have more difficulties with this coping strategy. These results provide a better understanding of psychological determinants of HQL in CKD, which can initiate another approach of these patients by nephrologists, specific psychological interventions, or other supporting public health services.

Post‐traumatic stress symptoms among mothers of children with leukemia undergoing treatment: a longitudinal study

To assess post-traumatic stress symptoms (PTSS) in mothers of children over 2 years of leukemia treatment, to identify possible early family and child predictors of this symptomatology and to indicate the temporal trajectory of PTSS. Participants were 76 Italian mothers (mean age = 37.30 years; SD = 6.07) of children receiving treatment for acute lymphoblastic (n = 69) or myeloid (n = 7) leukemia. Mothers had 12.05 years of education (SD = 3.87), and their incomes were average (52.1%), high (26%) and low (21.9%) for Italian norms, never in poverty. The pediatric patients with leukemia were equally distributed by gender with their mean age of 7.10 years (SD = 4.18). Post-traumatic stress symptoms were measured by a 17-item checklist. Scales assessing anxiety, depression, physical (Brief Symptom Inventory 18) and cognitive functioning (Problem Scale), and life evaluation were also used. There were five assessment points: 1 week (T1), 1 month (T2), 6 months (T3), 12 months (T4) and 24 months post-diagnosis (T5). The main results indicated moderate presence of clinical PTSS (≥9 symptoms: 24% at T2, 18% at T3, 16% at T4 and 19% at T5) that remained stable across time points, whereas Brief Symptom Inventory 18 Global score decreased and life evaluation improved. A series of hierarchical regression models identified cognitive functioning early after the diagnosis as the best predictive factor of PTSS across time points. Specific psychological interventions could be devised for mothers at risk for short and long-term PTSS just after the diagnosis.

Dokumentation komorbider psychischer Störungen in der medizinischen Rehabilitation: Eine Analyse ärztlicher Entlassungsberichte

Patients with chronic somatic -diseases often suffer from psychological distress and mental disorders, which remain unrecognized in somatic rehabilitation. The present -study aimed to investigate whether the implementation of a stepwise psychodiagnostic procedure improves the documentation of psychological distress and mental disorders as well as of the -related inpatient treatments and aftercare recommendations. Implementation of a stepwise psychodiagnostic procedure in 5 orthopaedic, cardiologic and oncologic inpatient rehabilitation clinics. The 4 steps comprised (1) screening, (2) in-depth psychodiagnostic assessment, (3) diagnosis and treatment, (4) documentation. Implementation efficacy in terms of a better documentation was evaluated by comparing the discharge reports of every fifth screening-positive and screening-negative patient (n=146) with historical discharge reports of the last 3 months preceding baseline assessment (n=161). Mental disorders (26,0% vs. 21,7%), general psychological treatment (75,3% vs. 66,5%), specific psychological treatment (32,9% vs. 31,7%), as well as psychologically relevant aftercare recommendations (41,1% vs. 34,8%) were more frequently documented in the current post-implementation discharge reports compared to the historical discharge reports. A significant difference was found only for the documentation of general psychological treatment. The results suggest that the implementation of a stepwise psychodiagnostic procedure improves the documentation of psychological distress and mental disorders as well as related inpatient treatments and aftercare recommendations. Continuous staff training and quality assurance relative to the discharge reports may contribute to further enhancing the documentation of psychological distress and mental disorders.

Practitioner Review: Self‐harm in adolescents

Repeated self-harm in adolescents is common and associated with elevated psychopathology, risk of suicide, and demand for clinical services. Despite recent advances in the understanding and treatment of self-harm there have been few systematic reviews of the topic. The main aim of this article is to review randomised controlled trials (RCTs) reporting efficacy of specific pharmacological, social or psychological therapeutic interventions (TIs) in reducing self-harm repetition in adolescents presenting with self-harm. Data sources were identified by searching Medline, PsychINFO, EMBASE, and PubMed from the first available year to December 2010. RCTs comparing specific TIs versus treatment as usual or placebo in adolescents presenting with self-harm were included. Fourteen RCTs reported efficacy of psychological and social TIs in adolescents presenting with self-harm. No independently replicated RCTs have been identified reporting efficacy of TIs in self-harm reduction. Developmental Group Psychotherapy versus treatment as usual was associated with a reduction in repeated self-harm, however, this was not replicated in subsequent studies. Multisystemic Therapy (MST) versus psychiatric hospitalisation was associated with a reduction of suicidal attempts in a sample of adolescents with a range of psychiatric emergencies. However, analyses focusing only on the smaller subgroup of adolescents presenting with deliberate self-harm at the initial psychiatric emergency, did not indicate significant benefits of MST versus hospitalisation. Further research is urgently needed to develop TIs for treating self-harm in adolescents. MST has shown promise but needs to be evaluated in a sample of adolescents with self-harm; dialectic behavioural therapy and cognitive behavioural therapy for self-harm require RCTs to evaluate efficacy and effectiveness.

P-761 - Depression is a hidden complicating factor in diabetic women with obesity

Introduction According to WHO reports, the risk of chronic noncommunicable diseases increases with raised body mass index and females have both obesity and depression rates higher. Aims To analyze the association obesity-psychiatric disorders in patients with diabetes and modified BMI, by gender. Methods We assessed emotional (HADS,PHQ,MADRS,HAM-A), cognitive (MMSE, clock test), and medical status in 50 consecutively admitted patients (March-June 2011), in our medical ward. Results Sex ratio F/M:35 / 15; the mean duration of diabetes was lower in women: 9 vs. 15 years; at least two of diabetes complications have been noted in similar proportions, 62% vs. 66%; obesity / overweight ratio women =3:1/ men = 1:1; men being treated mostly with OAD (73.3% vs. 42.8%). Stressful life events, in the past year, have been reported mostly in men (60% vs. 40%).Anxiety (F/M - 22.8% / 20%), insomnia (F/M - 68% / 60%), and an average score of 27 in MMSE were similarly present in both sexes. Depression was strikingly more common in females (clinical depression F/M: 40% / 26.6%, subclinical depression F/M: 22.8% / 13.3%). Conclusions Untreated clinical and subclinical symptoms of depression in women with diabetes and modified body mass index is a rule, and the aspect appears to be chronic. In men unspecific anxious-depressive symptoms and insomnia could be a reaction to a stressful life event.The results raise the suspicion that depression is a hidden complicating factor in diabetic women with obesity. In this group, early specific psychiatric and psychological interventions may improve the multidisciplinary treatment team approach.

Psychological Issues after Cardiac Transplantation: A Case Study

Progressive improvement in the techniques of cardiac surgery together with the emergence of cyclosporine as a powerful immunosuppressive agent have led to a resurgence of interest in cardiac transplantation. Despite its life-saving function, the same technical environment with its range of restrictions can lead to physical and emotional stress. Psychosocial implications and psychiatric morbidity are worth considering, but scarcely investigated. Further, severe life-threatening illness followed by high technology support and heart transplantation does not only affect the life of the patients but their whole family, especially the spouses’ life and could represent a traumatic event in their lives. The present case gave us the opportunity to consider the causes and clinical findings and review the specific psychological interventions for patients with end-stage heart disease.

Reflections on consulting in elite youth male English cricket and soccer academies

This article shares a joint reflection of two psychoeducation programmes delivered to athletes aged 13 to 18 years at two professional academies – cricket and soccer. These season-long programmes followed a cognitive-developmental framework, changing and adapting cognitive-behavioural techniques to benefit elite youth athletes. Initial elements of the programme focused on the 5C’s: commitment, communication, concentration, control, and confidence (Harwood, 2008) which also included team building sessions and one-to-one consultations. Feedback from players and academy directors revealed that the work was suitable and effective for their needs. We have reflected on the delivery of the programme and the challenges encountered, especially: time, funding, specific youth sport psychological intervention frameworks, credibility, confidentiality, determining effectiveness, professional boundaries, and relationships. Finally, we offer future directions on how to integrate psychoeducation programmes for professional sport academies.

Treatment of Apathy in Huntington’s Disease and Other Movement Disorders

Apathy is one of the most prevalent neurobehavioral symptoms in Huntington's disease (HD), occurring in approximately 70% of the symptomatic HD population. Apathy scores in patients with HD are highly correlated with duration of illness, suggesting that apathy is an inevitable consequence of advanced disease. Although less distressing than symptoms like depression and less disruptive than irritability or aggression, apathy has a considerable adverse impact on those affected with HD because it leads to a decrease of the goal-directed behaviors that contribute much to the day-to-day quality of life. As a neuropsychiatric syndrome, apathy is also common in patients with other neuropsychiatric disorders such as Parkinson's disease, traumatic brain injury, cerebrovascular accident, dementia, and other neurodegenerative conditions. The nosologic status of apathy and lack of a clear definition has probably contributed to the paucity of therapeutic evidence in this area. Several different scales are available to measure apathy, including the Apathy Evaluation Scale, Apathy Inventory, Lilles Apathy Rating Scale, and the apathy items from the Unified HD Rating Scale, the Problem Behaviours Assessment for HD, and the Neuropsychiatric Inventory, but all are based on slightly different definitions of apathy, so the scores obtained may not be directly comparable. Assessment may also be complicated by overlap between the manifestations of apathy and other complications of HD such as depression, so the identification and treatment of these comorbid conditions is important. No adequate evidence currently supports any specific pharmacologic or psychological intervention for apathy in HD. Evidence can only be extrapolated from interventional studies done in other basal ganglia disorders such as Parkinson's disease or other neurodegenerative disorders such as dementia. The neurobiology of apathy points towards three areas of functional connectivity: connections between the dorsolateral prefrontal cortex (PFC) and basal ganglia, orbitomedial PFC and basal ganglia, and dorsomedial PFC and basal ganglia. Pharmacologic interventions such as cholinesterase inhibitors, the dopaminergic antidepressant bupropion, amantadine, levodopa, bromocriptine, methylphenidate, and atypical antipsychotics have all been tried in other neurodegenerative disorders, but not in HD. Psychosocial interventions such as cognitive stimulation therapy and multisensory stimulation, which have been used in patients with dementia, have not been properly studied in HD. Individualized treatment should be considered, using a combination of methods, as there is no evidence to support one particular type of treatment. Multidisciplinary input, environmental modifications, improved psychosocial support, and psychoeducation programs designed to help caregivers to understand and compensate for the deficits caused by this symptom may all have a role to play in the treatment of apathy.

Appearance concerns in ophthalmic patients

This study aimed to determine the psychosocial and appearance-related concerns of a sample of ophthalmic patients by measuring a range of psychological, social, and demographic factors. Standardized psychological measures including anxiety, depression, appearance-related distress, self-discrepancy, appearance salience and valence were administered to 98 participants attending ophthalmic outpatient clinics in either London, Bristol, Sheffield or Bradford. Differences between groups were explored using t-tests and ANOVA, relationships between all variables were investigated using Pearson's correlation coefficient. Although mean scores for psychological adjustment were within the normal range, some participants were experiencing considerable levels of generalized anxiety. Being older, male, and married or living with a partner was related to significantly better adjustment. Better adjustment was also related to a less visible area of concern, greater disguisability of the affected area, a more positive evaluation of their own appearance, less engagement in comparing themselves with others, greater feelings of being accepted by others, appearance being less important to their self-concept, and a smaller discrepancy between the persons ideal and actual appearance. A majority of ophthalmic patients adjust positively to the demands placed on them. By identifying the variables that are associated with successful adaptation, the specific psychological interventions and appropriate systems of support can be put in place to help those who are adversely affected.

Effect of mental intervention on the psychological health status of the induced dialysis patients

Objective To investigate the effect of mental intervention to the psychological health status of the patients with dialysis. Methods 50 patients with induced hemodialysis were selected in the First People's Hospital of Hefei and investigated by symptom checklist (SCL-90) for psychological status. Specific psychological and behavior interventions were implemented by the investigation results and the psychological health status of the patients with dialysis were compared before and after intervention. Results The results about positive items of symptom checklist (SCL-90) after enforcing the intervention study were significantly lower than those before intervention ( P ＜ 0. 05 ), especially about body symptoms, compulsion, anxiety, depression,dread, hostility and interpersonal relationship. Conclusions Comprehensive mental intervention could improve the negative emotion and increase the healthy status of induced dialysis patients. Key words: Mental intervention; Induced dialysis; Psychological health status

Specific Psychological Treatment Versus Treatment as Usual in Adolescents with Self-Harm

Despite recent advances in the understanding and treatment of self-harm, poor engagement with therapy remains a serious problem. To investigate whether offering specific psychological treatment (SPT) leads to better engagement than offering treatment as usual (TAU) in adolescents who have self-harmed. Data sources were identified by searching Medline, PsychINFO, EMBASE, and PubMed for randomized controlled trials comparing SPT versus TAU in adolescents presenting with self-harm. Seven studies met inclusion criteria, and six were entered into the meta-analysis. There was no statistically significant difference between the number of subjects not completing four or more sessions of an SPT (27.7%, 70/253) than TAU (43.3%, 106/245), RR = 0.71 (95% CI: 0.49-1.05). Engaging adolescents with psychological treatment is necessary although not sufficient to achieve treatment goals. Further research is needed to develop tools for maximizing engagement.

Phenomenological Aspects of Complementarity and Entanglement in Exceptional Human Experiences (ExE)

The mental system of an individual usually generates a reality-model that includes a self-model and a world-model as fundamental components. Exceptional experiences (ExE) can be classified as subjectively experienced anomalies in the self-model or the world-model or in the relation of both. Empirical studies show significant correlations between specific patterns of ExE and socially and clinically relevant variables. In order to examine the ontological status of anomalous phenomena a psychophysical approach is presented in which the principle of complementarity is of fundamental importance. Applying a generalized quantum theory to psychosocial and psychophysical systems, complementary aspects such as autonomy versus reliability or novelty versus confirmation are identified as possible local and global variables. The findings indicate that entanglement correlations could play a role in the occurrence of ExE and that specific psychological interventions can dissolve them.

Noncompliance with Medical Regimen in Haemodialysis Treatment: A Case Study

Patients undergoing haemodialysis treatment have a high burden of disease (particularly cardiovascular comorbidities) affecting their quality of life and dramatically shortening life expectancy. Effective chronic kidney disease (CKD) control requires regular preventive medication and a response to that medication. Poor receptiveness to CKD medication can be related to individual variability in the dose needed to achieve a response, as well as to low-adherent behaviour in relation to the CKD medication regimen. Some patients, though not many, according to studies' findings, abuse the medical regimen as a result of suicidal tendencies. The present case gave us the opportunity to consider the causes and clinical findings and review the specific psychological interventions for patients with CKD.

Nursing of post-surgical patients of renal transplantation complicated with severe pulmonary infection

Objective To investigate the nursing of post-operational patients of renal transplantation complicated with severe pulmonary infection.Methods A total of 22 post-operational patients of renal transplantation complicated with severe pulmonary infection were applied psychological care, medicine management, ventilator-assisted care.Results In this group, 16 patients (72%) were cured , 5 patients (23%) died and 1 patient (5%) missfollowed.Conclusions Specific psychological intervention, the use of antibiotics and ventilator-assisted are important for recovering of post-operational patients complicated with severe pulmonary infection. Key words: Kidney transplantation; Pulmonary infection; Nursing

A systematic review of interventions to enhance medication adherence in children and adolescents with chronic illness

IntroductionPoor medication adherence is common in children and adolescents with chronic illness, but there is uncertainty about the best way to enhance medication adherence in this group. The authors conducted...

Smoking Relapse Prevention Programs and Factors That Predict Abstinence: A Controlled Study Comparing the Efficacy of Workplace Group Counselling and Proactive Phone Counselling

AbstractAims:Most smokers who quit smoking usually relapse. Smoking relapse prevention programs are thus needed and their optimal content and duration should be therefore studied. The present study aimed to compare the efficacy of two relapse prevention programs designed for subjects who reported to be abstinent after a smoking cessation program and to assess predictors of abstinence 9 months later.Participants and design:Two-hundred and seventy-five adults who reported to be abstinent were randomised in two 9-month relapse prevention programs: Workplace Group Counselling Program (WGC) or Proactive Phone Counselling Program (PPC).Measurements:Assessment included questionnaires (Brief Symptom Inventory, BSI; Dutch Eating Behavior Questionnaire, DEBQ; Life Event Scale; sociodemographic and companies' characteristics; and companies' policy toward smoking), and abstinence measurements (self-report, breath carbon monoxide level and urinary cotinine concentration level).Findings:Quit rates at 9 months were respectively 57.5% in the PPC arm and 61.7% in the WGC arm (p= .552). Regression analysis indicated that urinary cotinine concentration level lower than or equal to 317ng/ml was associated with higher rate of abstinence (OR= 4.75, 95% CI = 1.23–18.30,p= .024). Moreover having higher BSI global severity index (OR= .36; 95% CI = .15–.83;p= .017), DEBQ external eating scores (OR= .67; 95% CI = .45–1.00;p= .050) and a free program (OR= .46; 95% CI = .22–.99;p= .048) were associated with lower rate of abstinence.Conclusions:Efficacy was similar for the two programs. This study underlines the need to monitor distress, eating behaviours, lapses and motivation, and to include in future relapse prevention programs specific psychological and/or pharmacological interventions that consider these dimensions.

Pretreatment and outcome correlates of past sexual and physical trauma in 118 bipolar I disorder patients with a first episode of psychotic mania

To assess the prevalence and correlates of childhood and adolescent sexual and/or physical abuse (SPA) in bipolar I disorder (BDI) patients treated for a first episode of psychotic mania. The Early Psychosis Prevention and Intervention Centre admitted 786 first-episode psychosis patients between 1998 and 2000. Data were collected from patients' files using a standardized questionnaire. A total of 704 files were available; 43 were excluded because of a nonpsychotic diagnosis at endpoint and 3 due to missing data regarding past stressful events. Among 658 patients with available data, 118 received a final diagnosis of BDI and were entered in this study. A total of 80% of patients had been exposed to stressful life events during childhood and adolescence and 24.9% to SPA; in particular, 29.8% of female patients had been exposed to sexual abuse. Patients who were exposed to SPA had poorer premorbid functioning, higher rates of forensic history, were less likely to live with family during treatment period, and were more likely to disengage from treatment. SPA is highly prevalent in BDI patients presenting with a first episode of psychotic mania; exposed patients have lower premorbid functional levels and poorer engagement with treatment. The context in which such traumas occur must be explored in order to determine whether early intervention strategies may contribute to diminish their prevalence. Specific psychological interventions must also be developed.

Treatment of Cannabis Use Among People With Psychotic or Depressive Disorders

This article systematically reviews the evidence from randomized controlled trials (RCTs) for pharmacologic and psychological approaches to the treatment of cannabis use among individuals with psychotic or depressive disorders. A systematic literature search was conducted using the PubMed and PsychINFO databases from inception to December 2008. Individual searches in cannabis use (search terms: marijuana, cannabis, marijuana abuse, cannabis abuse, marijuana usage, cannabis usage), mental disorders (search terms: mood disorders, affective disorders, anxiety disorders, anxiety, depressive disorder, depression, psychotic disorders, psychosis, mental disorders), and pharmacotherapy (search terms: medication, drug therapy, pharmacotherapy, psychopharmacology, clinical trials, drug trial, treatment trial) were conducted and limited to humans, adolescents and adults. A search combining the individual cannabis use, mental disorder and pharmacotherapy searches produced 1,713 articles (PubMed = 1,398; PsychINFO = 315). Combining the cannabis use and mental disorder searches while limiting them to English articles and RCTs produced a total of 286 articles (PubMed = 228; PsychINFO = 58). From this literature, there were 7 RCTs conducted among mental health clients that reported cannabis use outcomes using pharmacologic or psychological interventions. While few RCTs have been conducted, there is evidence that pharmacologic and psychological interventions are effective for reducing cannabis use in the short-term among people with psychotic disorders or depression. Although it is difficult to make evidence-based treatment recommendations due to the paucity of research in this area, available studies indicate that effectively treating the mental health disorder with standard pharmacotherapy may be associated with a reduction in cannabis use and that longer or more intensive psychological interventions rather than brief interventions may be required, particularly among heavier users of cannabis and those with more chronic mental disorders. Specific recommendations regarding the type and length of specific psychological treatments cannot be made at this time, although motivational interviewing and cognitive-behavioral therapy approaches appear most promising.