Therapeutic Dropout Research Articles

Navigating the transition: a multidisciplinary approach to inflammatory bowel disease in children

PurposeA multidisciplinary approach to Inflammatory Bowel Disease (IBD) has recently demonstrated a positive impact in pediatric patients, reducing dropout rates and facilitating the transition to adult care. Our study aims to evaluate how this approach influences disease activity, dropout rates, and transition.MethodsWe conducted a longitudinal observational study including all patients diagnosed with IBD during pediatric-adolescent age, with a minimum follow-up period of 12 months. For each patient, endpoints included therapeutic approach, need for surgery and transition features.ResultsWe included 19 patients: 13 with Ulcerative Colitis (UC) and 6 with Crohn’s disease (CD). Most patients required multiple lines of therapy, with over 50% in both groups receiving biological drugs. Compliance was good, with a single dropout in each group (10, 5%). The need for surgery was significantly higher in the CD group compared to the UC group (16% vs. 7.7%, p < 0.01). Mean age at transition was significantly higher in the UC group compared to the CD group (19.2 ± 0.7 years SD vs. 18.3 ± 0.6 years SD, p < 0.05).ConclusionsIn our experience, the multidisciplinary approach to IBD in transition-age patients appears effective in achieving clinical remission, offering the potential to reduce therapeutic dropouts.

Study on Therapeutic Dropout Rates of a Pediatric Population in South-Eastern Central Europe, Dependent on Individual Particularities

Specialized studies conducted in the last decade have shown that the therapeutic success of specific treatment with tuberculostatic drugs, along with the decrease in the risk of relapse are elements that can only be achieved by increasing patients’ adherence to treatment. This is of paramount importance, especially for pediatric populations, as they are subject to a higher rate of therapeutic dropout, dependent on a number of individual particularities (from socio-demographic characteristics, to the incidence of depressive disorders, to pathological personal history, etc.). When we talk about patient behavior, we refer to how he/she complies with the specialist’s recommendation regarding: medication administration; following a diet; lifestyle changes.

Experiencing some Improvement is Associated with Premature Therapy Dropout

Therapeutic dropout is an a priori detrimental phenomenon that frequently occurs in psychotherapy. This work aims to study the factors that may influence therapy dropout. An analysis was carried out on a sample of 298 users of the Applied Psychology Center of the Autonomous University of Madrid. Of these users, 88(29.5%) dropped out of therapy before its completion. The results show that the presence of severe symptoms at the beginning of therapy according to the therapist’s criteria, and the diagnosis of anxiety problems, are associated with a higher dropout rate. In addition, it is observed that people who drop out have experienced significant improvement prior to leaving the treatment and show a high level of adaptation to the environment at the time of dropout. According to the therapist’s evaluation, however, those who complete the therapeutic process show a greater improvement. The implications of the study are discussed.

FACTORS INTERFERING WITH THE COURSE OF TREATMENT FOR ANXIETY DISORDERS: PROLONGATION AND PREMATURE TERMINATION OF TREATMENT

The efficacy and the effectiveness of anxiety disorder treatments have been proven. However, the desired results are not always achieved. Studying the factors that interfere with the natural course of the treatments could help to correct and to adapt them. Two of these factors are the unnecessary prolongation of treatments and premature termination. As expected, the duration of the treatment depends on the nature of the problem and the existence of comorbid problems, however also treatments that are too ambitious (an excess of techniques) or combined with pharmacological treatments (increasing sessions by up to 21%) have a longer duration. Premature termination was around 30-35% and patients “announce” their drop-out by displaying poorer task performance and more irregular attendance from the beginning. More than 50% of the therapeutic dropout occurs before the eighth session and 80% of successful treatments were completed before the 20th session

Vitamin D: Daily vs. Monthly Use in Children and Elderly-What Is Going On?

Vitamin D deficiency is highly prevalent among children and adults worldwide. Agreement exists that vitamin D deficiency should be corrected. However, the definitions of vitamin deficiency and effective vitamin D replacement therapy are inconsistent in the literature. Not only is the dosing regimen still under debate, but also the time and period of administration (i.e., daily vs. monthly dose). In pediatric as well as elderly subjects, dosing regimens with high vitamin D doses at less frequent intervals were proposed to help increase compliance to treatment: these became widespread in clinical practice, despite mounting evidence that such therapies are not only ineffective but potentially harmful, particularly in elderly subjects. Moreover, in the elderly, high doses of vitamin D seem to increase the risk of functional decline and are associated with a higher risk of falls and fractures. Achieving good adherence to recommended prophylactic regimens is definitely one of the obstacles currently being faced in view of the wide segment of the population liable to the treatment and the very long duration of prophylaxis. The daily intake for extended periods is in fact one of the frequent causes of therapeutic drop-outs, while monthly doses of vitamin D may effectively and safely improve patient compliance to the therapy. The aim of our paper is a quasi-literature review on dosing regimens among children and elderly. These two populations showed a particularly significant beneficial effect on bone metabolism, and there could be different outcomes with different dosing regimens.

The Effect of Expectations on Intention to Persist in Therapy

ABSTRACTLittle is known about the impact of expectations on persistence in couple and family therapy. A better understanding of the factors that contribute to persistence in therapy is key to understanding therapeutic dropout. We report results of a secondary grounded theory analysis of individual, couple, and family therapy clients' therapy expectations and their intention to persist in therapy. Participants were 19 clients of MFTs. Results indicate that clients carry expectations about the therapist, therapy process, duration, and outcome. Positive disconfirmation (Tambling & Johnson, 2010) of negative expectations contributed to therapy persistence.

Predictors of Dropout From Cognitive-Behavioral Group Treatment for Panic Disorder With Agoraphobia: An Exploratory Study.

Panic disorder and agoraphobia are both characterized by avoidance behaviors, which are known correlates of treatment discontinuation. The aim of this exploratory study is to distinguish the profile of participants suffering from panic disorder with agoraphobia that complete treatment from those who discontinue therapy by assessing four categories of predictor variables: the severity of the disorder, sociodemographic variables, participants' expectations, and dyadic adjustment. The sample included 77 individuals diagnosed with panic disorder with agoraphobia who completed a series of questionnaires and participated in a cognitive-behavioral group therapy consisting of 14 weekly sessions. Hierarchical linear regression analyses revealed the importance of anxiety, prognosis, and role expectations as well as some individual variables as predictors of therapeutic dropout, either before or during treatment. Among the most common reasons given by the 29 participants who discontinued therapy were scheduling conflicts, dissatisfaction with treatment, and conflicts with their marital partner. These results suggest that expectations and dyadic relationships have an impact on therapeutic discontinuation. The clinical implications of these findings are discussed.

Factors linked to severe thrombocytopenia during antiviral therapy in patients with chronic hepatitis c and pretreatment low platelet counts

BackgroundBaseline low platelet count (< 150,000/μL) increases the risk of on-treatment severe thrombocytopenia (platelet count < 50,000/μL) in patients with chronic hepatitis C (CHC) undergoing antiviral therapy, which may interrupt treatment. The purpose of this study was to identify risk factors for severe thrombocytopenia during treatment for CHC in patients with baseline thrombocytopenia.MethodsMedical records were reviewed for 125 patients with CHC treated with antiviral therapy according to the standard of care, with regular follow-up examinations. Early platelet decline was defined as platelet decrease during the first 2 weeks of therapy.ResultsSevere thrombocytopenia developed in 12.8% of patients with baseline thrombocytopenia, and predicted a higher therapeutic dropout rate. Multivariate analysis revealed baseline platelet count < 100,000/μL and rapid early platelet decline (> 30% decline in the first 2 weeks) were significantly associated with severe thrombocytopenia (P < 0.001 and 0.003, odds ratios, 179.22 and 45.74, respectively). In these patients, baseline PLT ≥ 100,000/μL and lack of rapid early platelet decline predicted absence of severe thrombocytopenia (negative predictive values were 95.1% and 96.6%, respectively). In contrast, baseline platelet count < 100,000/μL combined with rapid early platelet decline predicted severe thrombocytopenia (positive predictive value was 100%).ConclusionsFor patients with CHC on antiviral therapy, baseline platelet counts < 100,000/μL and rapid early platelet decline can identify patients at high risk of developing on-treatment severe thrombocytopenia.

The assimilation of problematic experiences in the context of a therapeutic failure

Abstract A negative case–a therapeutic dropout–was analyzed with the Assimilation of Problematic Experiences Scale (APES). The APES has been devised from the assimilation model developed by Stiles and colleagues, and it has proven useful for describing the process of change. The APES describes assimilation as a sequence of eight stages which range from an experience being warded off, through being avoided, in vague awareness, then clarified, understood and solutions applied and finally, resolved and integrated into the self. The current study focuses on the case of Ana, who was being treated for reactive depression in five sessions of linguistic therapy of evaluation. The aims of this study were to describe the process of assimilation and to determine whether it showed the sawtooth pattern of progress found in other APES studies. Main results showed that Ana had difficulties in the process of assimilation, never reaching APES Stage 4 (insight). Ana remained at APES Stages 2 and 3. The sawtooth pattern was...

Abandonos terapéuticos registrados en el ámbito de la hiperactividad y los trastornos del comportamiento. Influencia de variables individuales y familiares

Throughout this work we are going to analyze the influence 01 the inlantile disorder (delicit attenlion-hyperactivity disorder and oppositional deliant disorder), Ihe methods 01 behavior management used by the parents and their condition in the continuity or therapeutic drop-out on the part 01 the children previously diagnosed. 62 children have participated (5-12 years) in this study. After the diagnosis, the register 01 the presence/ absence 01 patients lo the programmed sessions 01 treatment allowed us to differentiate three groups: a) children who relused the recommended therapy, b) children who, after several sessions, interrupted the treatment and c) patients who ended up the intervention programo The results show the slgnificanl influence 01 the diagnosed disorder and the methods 01 behavioural management adopted by the parents in the therapeutic drop-outs, whose rate is estimated in 37% 01 the cases, similar to the results 01 published investigations on the subject.

Interpreting the Inventory of Interpersonal Problems: subscales based on an interpersonal theory model.

There remains considerable debate about a theoretically interpretable subscale structure for the Inventory of Interpersonal Problems (IIP). In this paper items are extracted from the IIP to form a 40-item shortened version (the IIP-40) comprising eight subscales, each of five items, which conform to the eight octant positions within Birtchnell's interpersonal octagon: a version of interpersonal theory. The inter-item reliability of the subscale structure is found to be acceptable when tested against a sample of 150 pre-assessment for psychotherapy IIP completions within the Centre for the Study of Psychotherapy (CSP), University of Kent. The face validity is established through acceptable inter-rater reliability scores in an experiment using blind raters. Subscale scores are shown for patients within CSP and are found to be significantly different between genders in the octant positions of Upper Close and Neutral Distant. High scores in the octant position of Upper Distant is found to be a significant predictor of therapeutic drop-out. The results for gender and therapeutic engagement are consistent with other published work in the interpersonal theory field.