Psychotherapy literature, August 2008

Outcome of Additional Behaviour Therapy Including Treatment Discontinuation for Fluvoxamine Non-Responders with Obsessive-Compulsive Disorder.

Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.

PMID: 18716426 [PubMed - as supplied by publisher]

Functional Impairment in Patients with Remitted Bipolar Disorder.

Bipolar Disorders Program, Molecular Psychiatry Laboratory, Hospital Clinic of Porto Alegre, Porto Alegre, Brazil.

PMID: 18716425 [PubMed - as supplied by publisher]

Clinical Features and Functioning of Patients with Minor Depression.

Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, Pa., USA.

Background: The two essential features of minor depression are that it has fewer symptoms than major depression and that it is less chronic than dysthymia. This study describes the clinical features and functioning of outpatients with minor depression. Methods: Subjects with minor depression (with and without a prior history of major depression) were recruited through clinical referrals and community advertising. Assessments included the Structured Clinical Interview for DSM-IV (SCID), the 17-item Hamilton Rating Scale for Depression (HAM-D), the Inventory of Depressive Symptomatology-Self Report (IDS-SR) and Clinician Rated (IDS-C) scales, the Global Assessment of Functioning (GAF) scale, the Medical Outcomes Study 36-item Short-Form scale (MOS), and the Clinical Global Impressions Severity Scale (CGI). Data from previously published studies of major depression, minor depression, and normal controls were compared to our data set. Results: Minor depression is characterized primarily by mood and cognitive symptoms rather than vegetative symptoms; the functional impairment associated with minor depression is as severe as for major depression in several areas; minor depression occurs either independently of major depression or as a stage of illness during the long-term course of major depression, and minor depression patients with and without a history of major depression have similar levels of depressive severity and functional impairment. Conclusions: These findings support the notion that minor depression is an important clinical entity that fits within the larger spectrum of depressive disorders. Copyright © 2008 S. Karger AG, Basel.

PMID: 18716424 [PubMed - as supplied by publisher]

Association between Anxiety and Factors of Coagulation and Fibrinolysis.

Clinic for Psychosomatic Medicine and Psychotherapy, University of Bonn, Bonn, Germany.

Background: Psychological stress and anxiety have been shown to produce an activation of coagulation and fibrinolysis. Resulting hypercoagulability is a risk factor for cardiovascular diseases, and could therefore contribute to an increased prevalence of coronary artery disease in anxiety patients. However, hemostasis function has not yet been studied in patients with clinically relevant anxiety disorders. Methods: A group of anxiety patients (panic disorder with agoraphobia or social phobia) and a healthy control group (each n = 29) completed some questionnaires [SCL-K9 (a short form of the SCL-90-R), State Trait Anxiety Inventory, ADS (general depression scale)], and had blood drawn after a 15-min rest period. To assess the reaction of the hemostatic system by global entities, sum scores were computed from parameters of coagulation and fibrinolysis (fibrinogen, FVII, FVIII, vWF, F1 + 2, TAT, D-dimer, alpha(2)-AP, PAP, tPA, PAI-1). Interfering variables, such as age, gender, alcohol consumption and smoking status, were controlled. Results: Anxiety patients scored higher in a composite hemostatic score and a sum score of fibrinolysis in comparison to the control group, with a predominant activation of inhibitors in fibrinolysis. However, the psychological variable with the closest association to hemostasis was not trait anxiety, but self-perceived worry about blood drawing before blood sampling was performed. Conclusions: The coagulation and fibrinolysis system is activated in the direction of a hypercoagulable state in patients with severe phobic anxiety, triggered by fear of blood drawing. This could be one mediating factor for the increased risk of cardiovascular diseases in this population. Acute situational phobic anxiety should be monitored closely when studying the association between anxiety and hemostasis. Copyright © 2008 S. Karger AG, Basel.

PMID: 18716423 [PubMed - as supplied by publisher]

Minor Psychiatric Disorders and Syncope: The Role of Psychopathology in the Expression of Vasovagal Reflex.

Department of Cardiology, 'Attikon' University Hospital of Athens, Athens, Greece.

Background: A high prevalence of minor psychiatric disorders (MPDs) has been reported in patients with vasovagal syncope (VVS). However, the relationship between the psychiatric substrate and syncope remains unclear. Methods: In order to test the hypothesis that MPDs may predispose to VVS, we assessed the prevalence of syncope, the response to head-up tilt test (HUTT) and the efficacy of psychiatric drug treatment in reducing syncopal episodes, in patients with recently diagnosed MPDs. The response to HUTT was compared with that in an equal number of matched (a) patients with VVS and (b) healthy controls. Results: A high rate of patients with MPDs (58%) had a positive HUTT. Additionally, 45% had a history of syncope; among them, the rate of positive HUTT was identical to that in the VVS group (83%). Following psychiatric drug treatment, the number of patients with syncope decreased in the MPD group (6/67 from 30/67, p < 0.01). Psychiatric symptoms and quality of life were also improved. The number of syncopal spells decreased equally in the MPD and VVS groups (0.6 +/- 0.5 from 2.5 +/- 1.4, p < 0.01, and 0.7 +/- 0.5 from 2.7 +/- 1.3, p < 0.01, respectively). Conclusion: A high proportion of patients with MPDs experience syncope, associated with a high rate of positive HUTT, comparable to that observed in VVS. Psychiatric treatment results in the improvement of syncopal and psychiatric symptoms. These findings suggest involvement of co-occurring MPDs in the pathogenesis of VVS. Therefore, the diagnosis and treatment of MPDs, when present, may be crucial for the effective therapy of vasovagal syndrome. Copyright © 2008 S. Karger AG, Basel.

PMID: 18716422 [PubMed - as supplied by publisher]

Promoting Resilience and Psychological Well-Being in Vulnerable Life Stages.

Mother and Child Department, University of Modena and Reggio Emilia, Modena, Italy.

PMID: 18703897 [PubMed - as supplied by publisher]

Predictors of Premature Termination of Day Treatment for Personality Disorder.

Department of Psychiatry, University of British Columbia, Vancouver, B.C., Canada.

Background: Premature termination is a common problem in the treatment of personality disorder. Efforts to improve compliance should begin by recognising risk factors for premature termination. This prospective study identified predictors of premature termination from a day treatment program for personality disorder. Methods: Consecutively admitted patients with a personality disorder (n = 197) were assessed with self-report and interview measures. Patient personality characteristics were the primary predictors. Others were demographic, initial disturbance, and personality disorder variables. Cox proportional hazards regression was used. Results: Risk of terminating prematurely significantly increased if the patient had been previously hospitalised for psychiatric difficulties, was younger, had fewer prior contacts with health and social services, and had more severe borderline personality disorder traits. Conclusions: Information about which patients are at high risk for premature termination can help clinicians take measures to modify the risk. This might involve selection decisions, pre-treatment preparation, close monitoring during treatment, or addition of adjunctive interventions. Copyright © 2008 S. Karger AG, Basel.

PMID: 18701833 [PubMed - as supplied by publisher]

Identifying Patients at Risk of Complete Nonresponse in the Outpatient Treatment of Depression.

Depression Research Group, Mentrum Mental Health Care, Amsterdam, The Netherlands.

Background: Although complete nonresponse in depression treatment is considered to be a major problem in clinical practice, research in this area is very limited. The objective of this preliminary study was to determine the frequency and predictors of complete nonresponse in different treatments for depression. Methods: Post hocanalysis of the pooled data of 3 consecutive randomized controlled trials of outpatient depression treatment was conducted. The subjects were 313 patients with major depressive disorder and 17-item Hamilton Rating Scale for Depression (HAM-D-17) scores between 14 and 25 who were treated for 6 months with either pharmacotherapy, short-term psychodynamic supportive psychotherapy or combined therapy. Complete nonresponse was defined as a <25% response according to the HAM-D-17. Sociodemographic factors, depression features and adherence were investigated as predictors in a multivariate stepwise logistic regression analysis. Results: Overall, nonresponse occurred in 34% of the patients. In pharmacotherapy this was 46%, in psychotherapy 39% and in combined therapy 28%. The severity of somatic symptoms was associated with nonresponse in both combined therapy and psychotherapy. No predictive factors were found in the case of pharmacotherapy. In psychotherapy, nonresponse was related to age above 40 years, chronic depression and nonadherence by the patient. In the case of combined therapy, younger age, previous use of an antidepressant and having a previous depressive episode were associated with nonresponse. Conclusion: Easily measurable patient characteristics may help to identify patients at risk of complete nonresponse to treatment. It is suggested that predictors may differ across treatment modalities. However, head-to-head comparisons are required before it can be recommended to take this into account when selecting the most appropriate treatment for individual depressed patients. Copyright © 2008 S. Karger AG, Basel.

PMID: 18701832 [PubMed - as supplied by publisher]

Short-Term Psychodynamic Psychotherapy and Fluoxetine in Major Depressive Disorder: A Randomized Comparative Study.

Department of Psychiatry, University of Helsinki, Helsinki, Finland.

Background: There are few studies comparing the efficacy of short-term psychodynamic psychotherapy (STPP) and pharmacotherapy in major depressive disorder. We conducted a comparative study on the efficacy of STPP versus fluoxetine treatment in patients with major depressive disorder in a primary care setting. Methods: Fifty-one patients with major depressive disorder (DSM-IV) of mild or moderate severity were recruited through occupational health services providing primary health care. Patients were randomized to receive either STPP (1 session/week) or fluoxetine treatment (20-40 mg/day) for 16 weeks. The outcome measures included the Hamilton Depression Rating Scale (HDRS), the Beck Depression Inventory (BDI), and the Social and Occupational Functioning Assessment Scale (SOFAS). Results: Intent-to-treat analyses indicated that both treatments were highly effective in reducing the HDRS (p < 0.0001) and BDI (p < 0.0001) scores, as well as in improving functional ability (SOFAS; p < 0.0001), with no statistically significant differences between the treatments. Of those 40 subjects who completed the follow-up, 57% in the psychotherapy group and 68% in the fluoxetine group showed full remission (HDRS </=7) after 4 months. Conclusions: Both STPP and pharmacological treatment with fluoxetine are effective in reducing symptoms and in improving functional ability of primary care patients with mild or moderate depression. This study suggests no marked differences in the therapeutic effects of these two treatment forms in a primary care setting. Copyright © 2008 S. Karger AG, Basel.

PMID: 18701831 [PubMed - as supplied by publisher]

The Illness Attitude Scales. A Clinimetric Index for Assessing Hypochondriacal Fears and Beliefs.

Department of Psychology, University of Bologna, Bologna, Italy.

Background: The Illness Attitude Scales (IAS) were developed by Robert Kellner as a clinimetric index for measuring hypochondriacal fears and beliefs (worry about illness, concerns about pain, health habits, hypochondriacal beliefs, thanatophobia, disease phobia, bodily preoccupations, treatment experience and effects of symptoms). The IAS have been extensively used in the past two decades, but there has been no comprehensive review of their properties and applications. Methods: A review of the literature using both computerized (Medline, PsycINFO) and manual searches was performed. Results: The IAS were found to successfully discriminate between hypochondriacal patients and control subjects, and between patients with various manifestations of illness behaviour. They showed a high test-retest reliability in normal subjects, and changed in the expected direction after treatment of hypochondriasis. The IAS were also positively related to other hypochondriasis-related measures, and yielded important information in a variety of medical and surgical settings. Their content has paved the way for the development of some of the Diagnostic Criteria for Psychosomatic Research. Conclusions: The clinimetric properties and high sensitivity of the IAS make them the gold standard for the self-rated assessment of hypochondriacal fears and beliefs. Copyright © 2008 S. Karger AG, Basel.

PMID: 18701830 [PubMed - as supplied by publisher]

Association of hypertension with depression in community-dwelling elderly persons: results from the ZARADEMP Project.

PMID: 18701829 [PubMed - in process]

Moderators of the effects of treatment length in long-term psychodynamic group psychotherapy.

PMID: 18663333 [PubMed - in process]

The implementation of the NICE guidelines for schizophrenia: Barriers to the implementation of psychological interventions and recommendations for the future.

Purpose'Schizophrenia: Core Interventions in the Treatment and Management of Schizophrenia in Primary and Secondary Care' was the first National Institute of Clinical Effectiveness (NICE) guidance to be produced in 2002. This guidance includes a recommendation in relation to cognitive behavioural therapy (CBT) and family interventions (FI) in schizophrenia. This review reviews this guidance and assesses the extent of their imp