Use Of Psychotherapeutic Interventions Research Articles

Первинний хронічний біль як соматизація дистресу

Relevance. The direct functional significance of pain is to signal the action of a stimulus, damage to the integrity of the organism or its individual structures. A number of scientists have approached the study of pain as a physiological defense mechanism, during which we understand the principles of its emergence, course, localization, and ways to overcome pain sensations through pharmacological, physical, and instrumental methods. However, the problem of pain arises when the physiological substrate is absent or does not correspond to the strength or duration of the manifestation. This is where we can talk about pain of a psychogenic nature, which despite a number of studies that are currently underway, still remains difficult to treat. Objective. To improve the effectiveness of medical-psychological assistance by studying the nature and patterns of pain syndrome in patients with primary chronic pain with subsequent psycho-correction and the use of psychotherapeutic interventions. Methods. The study design was a monocentric randomized controlled trial with parallel groups. The study involved 14 individuals with primary chronic pain syndrome, which corresponded to ethical and deontological norms according to the principles set out in the Helsinki Declaration. The tools used in the study included the SPAASMS subjective pain assessment scale, the somatic symptoms questionnaire (SSS-8), the Bass-Darky aggressiveness and hostility level questionnaire (BDHI), as well as the Chaban O.S. quality of life assessment scale (CQLS). Results. At the completion of the study, a statistically significant difference was observed for all clinical parameters between the experimental and control groups. Comparison of the values of the scale in the experimental group on days 1 and 42 demonstrated statistically significant changes in all four indicators. However, this study reveals a limited sample, which in turn allows for expanding the sample size and investigating the phenomenon of applied interventions in future pilot studies, as the primary results provide a qualitative and positive trend in reducing the effects and impact of primary chronic pain, as well as improving the quality of life indicator. Conclusions. The results of this study confirm the effectiveness of psychological interventions, as well as psychological interventions for reducing the subjective sensation of pain syndrome, symptoms of somatization, aggressive and hostile reactions, and improving the quality of life in individuals suffering from primary chronic pain.

Role of psychotherapy on antenatal depression, anxiety, and maternal quality of life: A meta-analysis.

Background:Depression and anxiety are common psychological manifestations encountered during the antenatal stage of pregnancy. Treatments by pharmacological interventions have been reported to impart negative implications on maternal and fetal health outcomes. Therefore, the use of psychotherapeutic interventions to bypass these side-effects and manage depression, anxiety has received a lot of attention. A meta-statistical consensus regarding the intervention is available, but with several limitations. In this study, we attempt to address these limitations and provide the current state of evidence evaluating the influence of psychotherapy on antenatal depression, anxiety, and maternal quality of life.Objective:To demonstrate the effects of psychotherapy on depression, anxiety, and maternal quality of life during the antenatal stage of pregnancy.Methods:A systematic identification of literature was performed according to PRISMA guidelines on four academic databases: MEDLINE, Scopus, EMBASE, and CENTRAL. A meta-analysis evaluated the influence of psychotherapy on depression, anxiety, and maternal quality of life as compared to conventional obstetric care.Results:Out of 1146 records, 22 articles including 2146 pregnant women (mean age: 28.6 ± 2.8 years) were included in this review. This systematic review presents a 1b level of evidence supporting the use of psychotherapy for reducing depression, anxiety and enhancing maternal quality of life. The meta-analysis reveals the beneficial effects of psychotherapy for reducing depression (Hedge g: −0.48), anxiety (−0.47) and enhancing maternal quality of life (0.19) as compared to conventional obstetric care.Conclusions:The current systematic review and meta-analysis recommend the use of psychotherapy as for reducing depression, anxiety and enhancing maternal quality of life during the antenatal stage of pregnancy.

Obsessive compulsive disorder in an adult patient with Gilles de la Tourette syndrome and expressed behavioral disorders (clinical case).

The article des­cribes the clinical case of obsessive-compulsive disorder in an adult patient with Gilles de la Tourette syndrome and severe behavioral disorders. The authors demonstrated the comorbidity of Gilles de la Tourette syndrome and obsessive-compulsive disorder. Obsessive thoughts and compulsive actions were diagnosed as the most frequent behavioral disorders in Tourette syndrome. It was indicated on gender as an additional sanctioning factor for the early onset of mental disorders. Obsessive-compulsive disorder in the patient was characterized by mixed obsessive thoughts and actions, had a protracted nature, with prolonged decompensations requiring treatment in a psychiatric hospital. Emotional instability, impulsivity, obsessions and compulsions affecting the social functioning of not only the patient himself, but also those around him, as well as pronounced behavioral disturbances led to social malajustment. When treating the patient, the doctors had to resort to a combination of typical neuroleptics with second-generation antipsychotics, mood stabilizers and antidepressants due to the poor response to pharmacotherapy. Comorbidity of mental disorders determined the complexity of therapeutic measures with the use of psychotherapeutic interventions, which made it possible to achieve an improvement in the mental state and avoid disability of the patient.

Perspectives and Opportunities for Psychotherapeutic Interventions in Inpatient Psychiatric Treatment Delivered by Nurses

Psychotherapy is an essential part of treating people with mental illness. However, the implementation of psychotherapeutic interventions in the field of inpatient psychiatric treatment remains well behind demand. At the same time, the use of psychotherapeutic interventions by other professional groups - such as social workers and nursing - is not a common practice in Germany. What can we learn from the international research with regard to nursing for Germany in view of the insufficient supply of psychotherapeutic care. Based on a literature analysis, the German situation of care is related to international developments and a German training curriculum is presented. A look at the international literature shows that in other countries especially trained nurses perform psychotherapeutic Interventions. In addition, there are effective training curricula whose transferability to Germany appears to be possible after appropriate adjustments.An 18 months lasting training program for nurses is presented. In addition to disorder-specific competences, this curriculum also provides psychotherapeutic interventions with a general approach. Collaborative care in the collaboration of different health professionals has been repeatedly and stably proven to be effective and helpful in treating people with various mental disorders. In order to better meet the growing need for psychotherapeutic interventions in the population in the sense of a stepped care model, trained nurses need to be more involved in the provision of psychotherapeutic services.

The International College of Neuro-Psychopharmacology (CINP) Treatment Guidelines for Bipolar Disorder in Adults (CINP-BD-2017), Part 3: The Clinical Guidelines.

Background:The current paper introduces the actual International College of Neuro-Psychopharmacology clinical guidelines for the treatment of bipolar disorder.Concept and structure of the guidelines:The current clinical guidelines are based on evidence-based data, but they also intend to be clinically useful, while a rigid algorithm was developed on the basis of firm evidence alone. Monotherapy was prioritized over combination therapy. There are separate recommendations for each of the major phases of bipolar disorder expressed as a 5-step algorithm.Discussion:The current International College of Neuro-Psychopharmacology clinical guidelines for the treatment of bipolar disorder are the most up-to-date guidance and are as evidence based as possible. They also include recommendations concerning the use of psychotherapeutic interventions, again on the basis of available evidence. This adherence of the workgroup to the evidence in a clinically oriented way helped to clarify the role of specific antidepressants and traditional agents like lithium, valproate, or carbamazepine. The additional focus on specific clinical characteristics, including predominant polarity, mixed features, and rapid cycling, is also a novel approach. Many issues need further studies, data are sparse and insufficient, and many questions remain unanswered. The most important and still unmet need is to merge all the guidelines that concern different phases of the illness into a single one and in this way consider BD as a single unified disorder, which is the real world fact. However, to date the research data do not permit such a unified approach.

Treatment of anxiety disorders by psychiatrists from the American Psychiatric Practice Research Network

Anxiety disorders are highly prevalent in the United States, and if untreated, result in a number of negative outcomes. This study aimed to investigate psychiatrists' current treatment practices for patients with anxiety disorders in the United States. Psychiatrist-reported data from the 1997 and 1999 American Psychiatric Institute for Research and Education Practice Research Network (PRN) Study of Psychiatric Patients and Treatments (SPPT) were examined, focusing on patients diagnosed with anxiety disorders. Information related to diagnostic and clinical features and treatments provided were obtained. Anxiety disorders remain underdiagnosed and undertreated, since only 11.4% of the sample received a principal diagnosis of an anxiety disorder in a real world setting. Posttraumatic stress disorder was associated with particularly high comorbidity and disability, and social anxiety disorder was relatively rarely diagnosed and treated. Although combined pharmacotherapy and psychotherapy was commonly used to treat anxiety disorders, anxiolytics were more commonly prescribed than selective serotonin reuptake inhibitors (SSRIs). These data provide a picture of diagnosis and practice patterns across a range of psychiatric settings and suggest that anxiety disorders, despite being among the most prevalent of psychiatric disorders remain underdiagnosed and undertreated particularly in respect of the use of psychotherapeutic interventions.

The use of psychotherapeutic interventions by primary care GPs in Ireland in the treatment of their methadone patients: a grounded theory study

The methadone protocol placed responsibility on general practitioners (GPs) for the methadone treatment of stabilised drug-addicted patients. The protocol emphasised a medico-pharmacological model with minor reference to psychotherapeutic treatment. This qualitative study investigated how primary care GPs in Ireland use psychotherapeutic interventions in the treatment of methadone patients. A grounded theory methodology was used. There is a wide variation in the beliefs and knowledge of methadone-prescribing GPs regarding the efficacy of psychotherapeutic interventions for patients on methadone maintenance. GPs do not formally integrate psychotherapeutic interventions into methadone patient treatment. Accessing psychotherapeutic services raises concerns for GPs in terms of availability, location and quality. Primary care GPs who offer methadone maintenance view opiate abuse as a health issue similar to other such issues within their community. They take a holistic view of their methadone patient and, without formal guidelines, develop individual approaches to the use of psychotherapeutic interventions. The absence of a framework for the use of psychotherapeutic interventions in primary care methadone treatment in Ireland militates against the development of a basis for improving practice.

Medically unexplained symptoms in young people: The doctor's dilemma

Medically unexplained symptoms in young people can present a challenge for primary care physicians to manage. Despite the prevalence of this clinical problem, physicians feel ill-equipped to deal with it. Families may attribute symptoms to an organic cause, despite the absence of identified pathology, and often resist considering psychosocial contributing factors. The present article outlines the key principles in the management of medically unexplained symptoms. Treatment focuses on building a therapeutic alliance with the patient and the family, the use of psychotherapeutic interventions and the role of psychopharmacology. A family-oriented rehabilitative approach to care, with a focus on functional improvement rather than symptom reduction, is emphasized.

Mood Disorders and Substance Use Disorder: A Complex Comorbidity

Mood disorders, including depression and bipolar disorders, are the most common psychiatric comorbidities among patients with substance use disorders. Treating patients' co-occurring mood disorders may reduce their substance craving and taking and enhance their overall outcomes. A methodical, staged screening and assessment can ease the diagnostic challenge of distinguishing symptoms of affective disorders from manifestations of substance intoxication and withdrawal. Treatment should maximize the use of psychotherapeutic interventions and give first consideration to medications proven effective in the context of co-occurring substance abuse. Expanded communication and collaboration between substance abuse and mental health providers is crucial to improving outcomes for patients with these complex, difficult co-occurring disorders.

Relationship between Psychosocial Distress, Treatment Need and Use of Psychotherapeutic Interventions within a Psychosomatic Liaison Service in Hematological Oncology

Psychosocial distress is common in patients with hematological malignancies in the acute phase of the disease. The aim of the study was to evaluate the treatment need and the realization of psychotherapeutic interventions of a routine psychosomatic liaison service delivery in hematological oncology.72 patients of the transplantation ward and of the general hematological oncological ward were consecutively included in the study. Assessments involved both self- and observer rating instruments.The need for psychotherapeutic treatment was 38 or 49%, depending on patients' or professional's view, respectively. 39% of the patients underwent psychotherapeutic treatment. But there was a great discrepancy between the treatment need estimated by observer and patients and the actual psychotherapeutic interventions.The utilization of psychotherapeutic interventions seems to be subject to a complex interaction between patient's need, 'objective' psychosocial distress and institutional conditions. The results highlight the importance of need for better identification of patients with psychosocial distress and better targeting of psychotherapeutic treatment.

Psychosomatic liaison service in hematological oncology: need for psychotherapeutic interventions and their realization.

Empirical investigations examining the psychosocial distress and need for care of inpatients with hematological malignancies are rare. Little is known about the use of psychotherapeutic interventions in routine care. To evaluate the psychosocial distress of hemato-oncological inpatients, the need for psychotherapeutic interventions and their realization in the framework of a psychosomatic liaison service has been assessed. Seventy-two patients from two hematological oncology wards underwent psychodiagnostic interviews and completed self-rating instruments, elucidating mental disorders, psychosocial distress, coping strategies, quality of life, treatment motivation and psychotherapeutic interventions. Using ICD-10 criteria, mental and behavioural disorders were diagnosed in 53% of patients. Professional assessment indicated a need for psychotherapeutic treatment in 49%, while 38% of the patients wished to receive psychological support. Actual intervention occurred for all patients in the bone marrow transplantation unit and for 23% of patients in the general hemato-oncological ward. There is considerable need for psychotherapeutic treatment which can only be handled within the framework of a liaison service in close cooperation with oncologists, nurses and mental health specialists.

Need and use of psychotherapeutic interventions within a psychosomatic liaison service in neurology.

The study addresses the evaluation of psychosocial distress, the need for care as determined by a psychotherapist and patients, and the realization of psychotherapeutic interventions within a routine psychosomatic liaison service. A total of 84 patients from one unit at the Department of Neurology of the University of Freiburg, Germany, underwent a structured psychodiagnostic interview and filled out self-rating instruments to evaluate mental disorders, psychosocial distress, ways of coping strategies and quality of life. The need for treatment and the motivation of patients were estimated by both patients and a liaison psychotherapist. Using ICD-10-F criteria, mental and behavioral disorders were diagnosed in 35% of cases. Professional assessment indicated a need for psychotherapeutic treatment in 37% of patients; actual intervention occurred in 27%. Only slight agreement was found between the estimated need for treatment and the interventions actually performed. The realization of psychotherapeutic interventions is subject to a complex interaction between the needs of a patient, the "objective" psychosocial distress of the patient, and institutional factors. About 10% of the hospitalized patients considered in the study need continuous psychotherapeutic treatment.

Psychosomatic Liaison Service in Dermatology

Background: Empirical investigations examining the psychosocial distress and need for care of dermatology patients are rare. Little is known about the use of psychotherapeutic interventions in routine care. Objective: To evaluate the psychosocial distress of dermatological inpatients, the need for psychotherapeutic interventions and their realization in the framework of a psychosomatic liaison service. Methods: 86 patients from one unit at the University Dermatology Clinic in Freiburg underwent psychodiagnostic interviews and completed self-rating instruments, elucidating mental disorders, psychosocial distress, coping methods, quality of life, treatment motivation and psychotherapeutic interventions. Results: Using ICD-10 criteria, mental and behavioral disorders were diagnosed in 46%; most frequent were mood and anxiety disorders. Professional assessment indicated a need for psychotherapeutic treatment in 51%, while 28% of the patients wished for psychotherapy; actual intervention occurred in 38%. Conclusions: The need for psychotherapeutic treatment can only be handled within the framework of a liaison service in close collaboration with care givers.

Drs. Levitan and Kornfeld Reply

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