Body, Mind & Spirit Articles and Latest News

Preventing recurrence of bipolar I mood episodes and hospitalizations: family psychotherapy plus pharmacotherapy versus pharmacotherapy alone.

Bipolar Disord. 2008 Nov;10(7):798-805

Authors: Solomon DA, Keitner GI, Ryan CE, Kelley J, Miller IW

Objectives: This study compared the efficacy of three treatment conditions in preventing recurrence of bipolar I mood episodes and hospitalization for such episodes: individual family therapy plus pharmacotherapy, multifamily group therapy plus pharmacotherapy, and pharmacotherapy alone. Methods: Patients with bipolar I disorder were enrolled if they met criteria for an active mood episode and were living with or in regular contact with relatives or significant others. Subjects were randomly assigned to individual family therapy plus pharmacotherapy, multifamily group therapy plus pharmacotherapy, or pharmacotherapy alone, which were provided on an outpatient basis. Individual family therapy involved one therapist meeting with a single patient and the patient’s family members, with the content of each session and number of sessions determined by the therapist and family. Multifamily group psychotherapy involved two therapists meeting together for six sessions with multiple patients and their respective family members, with the content of each session preset. All subjects were prescribed a mood stabilizer, and other medications were used as needed. Subjects were assessed monthly for up to 28 months. Following recovery from the index mood episode, subjects were assessed for recurrence of a mood episode and for hospitalization for such episodes. Results: Of a total of 92 subjects that were enrolled in the study, 53 (58%) recovered from their intake mood episode. The analyses in this report focus upon these 53 subjects, 42 (79%) of whom entered the study during an episode of mania. Of the 53 subjects who recovered from their intake mood episode, the proportion of subjects within each treatment group who suffered a recurrence by month 28 did not differ significantly between the three treatment conditions. However, only 5% of the subjects receiving adjunctive multifamily group therapy required hospitalization, compared to 31% of the subjects receiving adjunctive individual family therapy and 38% of those receiving pharmacotherapy alone, a significant difference. Time to recurrence and time to hospitalization did not differ significantly between the three treatment groups. Conclusion: For patients with bipolar I disorder, adjunctive multifamily group therapy may confer significant advantages in preventing hospitalization for a mood episode.

PMID: 19032711 [PubMed - in process]

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Understanding how and why psychotherapy leads to change.

Psychother Res. 2008 Nov 25;:1-11

Authors: Kazdin AE

The rich research literature on psychotherapies for children, adolescents, and adults has identified several interventions that can ameliorate or effect significant change in psychiatric disorders and a variety of social, behavioral, and emotional problems and can enhance medical outcomes and recovery. After decades of psychotherapy research and thousands of studies, there is no evidence-based explanation of how or why even the most well-studied interventions produce change, that is, the mechanisms through which treatments operate. This article discusses central requirements for demonstrating mediators and mechanisms of change. Also presented are promising lines of work to identify mediators and mechanisms, ways of bringing to bear multiple types of evidence, recommendations to make progress in understanding how therapy works, and conceptual and research challenges in evaluating mediators and mechanisms.

PMID: 19034715 [PubMed - as supplied by publisher]

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Compassion in psychotherapy: The perspective of therapists nominated as compassionate.

Psychother Res. 2008 Nov 25;:1-15

Authors: Vivino BL, Thompson BJ, Hill CE, Ladany N

Fourteen therapists nominated by peers as compassionate defined compassion in psychotherapy as connecting with the client’s suffering and promoting change through action. They indicated that compassion was broader and deeper than empathy, helps clients feel understood, and relieves symptoms. Although indicating that compassion was innate, therapists felt it could be further awakened. Factors facilitating compassion in therapy were therapists feeling clients’ suffering, understanding client dynamics, identifying with and liking clients, client involvement, and a good therapy relationship. Hindering factors included clients being resistant, being aggressive, having serious pathology, or violating boundaries; therapists having interfering personal issues, feeling incompetent, or having negative reactions to or not liking clients; and a poor therapy relationship. A theory regarding compassion in psychotherapy is proposed.

PMID: 19034730 [PubMed - as supplied by publisher]

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The real relationship in a postmodern world: Theoretical and empirical explorations.

Psychother Res. 2008 Nov 26;:1-12

Authors: Gelso CJ

A theory of the real relationship, including its place in the overall therapeutic relationship, is amplified. The real relationship is seen as a key component of all psychotherapy relationships. It exists from the first moment of contact between therapist and patient, and it deepens as the work progresses. Recently, reliable measures of the real relationship from the therapist’s and client’s perspectives have been developed, and these measures have demonstrated sound beginning validity. Studies have explored the variables with which the real relationship correlates and have demonstrated significant relationships to treatment progress and outcome. The real relationship appears to be a promising variable for future study, and potentially fruitful directions for such study are noted.

PMID: 19034731 [PubMed - as supplied by publisher]

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Stability of affect associated with autobiographical memories.

Nord J Psychiatry. 2008 Nov 26;:1-8

Authors: Poutanen O, Mattila AK, Salokangas RK, Joukamaa M

Childhood family atmosphere is a frequent topic in psychotherapy. Our aim was to assess the stability of affect associated with autobiographical memories. In a 7-year follow-up study of depression, 414 primary care patients and psychiatric outpatients both at baseline and at follow-up completed the self-inquiry Depression Scale (DEPS) and answered simple questions about the mental atmosphere in their childhood families. The prevalence and the distribution of changes in affect were calculated by cross-tabulation. Logistic regression analyses were used to assess associations between depressiveness and changes in affect. Nearly 50% of the sample had at least one change in the responses. Young age and male gender were significant predictors for changes. Depressiveness was associated with changes in miserable affect of the childhood home. Affect associated with autobiographical memories seems to change over a longer period. The association between depressiveness and changes in recollections is convoluted. The large number of changes of affects concerning autobiographical memories should be taken into account both in psychotherapy and in studies of life-long experiences. Future long follow-up studies with more specific multi-item measures on family atmosphere are needed.

PMID: 19034802 [PubMed - as supplied by publisher]

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META-ANALYSIS OF QUALITATIVE STUDIES: A TOOL FOR REVIEWING QUALITATIVE RESEARCH FINDINGS IN PSYCHOTHERAPY.

Psychother Res. 2008 Nov 26;:1-10

Authors: Timulak L

This article focuses on the presentation of qualitative meta-analysis as a method for reviewing qualitative studies. Qualitative meta-analysis is an attempt to conduct a rigorous secondary qualitative analysis of primary qualitative findings. Its purpose-to provide a more comprehensive description of a phenomenon and an assessment of the influence of the method of investigation on findings-is discussed. The distinctive features of conducting meta-analysis approaches are presented. Several considerations important for conducting qualitative meta-analysis are also discussed. The author uses examples of the first experiences attempted with qualitative meta-analysis in the field of psychotherapy research.

PMID: 19034804 [PubMed - as supplied by publisher]

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Severity of Bulimia Nervosa. Measurement and Classification into Health or Pathology.

Psychopathology. 2008 Nov 20;42(1):22-31

Authors: Hartmann A, Zeeck A, van der Kooij AJ

Aims: In order to identify the most important components of the severity of bulimia nervosa (as well as identifying clinical cases), we explored the relation between dimensional and categorical assessment. This was achieved by studying the performance of variables from standard instruments (measuring specific and general psychopathology) in predicting an expert rating of overall syndrome severity. Method: In total, 213 cases were selected (across the whole range of severity). We applied regression with optimal scaling to model nonlinear relations in the data, and the lasso method with bootstrapping for predictor selection. The best model contained 2 scales of the Eating Disorders Inventory (’bulimia’ and ‘drive for thinness’) and the frequency of the binges. The sensitivity and specificity of case classification using the obtained model was determined. Results: The model can predict the probability of being a clinical case at a rate of 88%. The presented statistical methods are innovative and promising approaches that can help researchers and clinicians to better define sets of variables for treatment evaluation and outcome studies. Conclusion: The results indicate that severity and outcome in bulimia nervosa should be determined by measuring both cognitive and behavioral aspects of the symptoms.

PMID: 19023231 [PubMed - as supplied by publisher]

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The Short Version of the Borderline Symptom List (BSL-23): Development and Initial Data on Psychometric Properties.

Psychopathology. 2008 Nov 20;42(1):32-39

Authors: Bohus M, Kleindienst N, Limberger MF, Stieglitz RD, Domsalla M, Chapman AL, Steil R, Philipsen A, Wolf M

Background: The full version of the Borderline Symptom List (BSL; for clarification now labeled BSL-95) is a self-rating instrument for specific assessment of borderline-typical symptomatology. The BSL-95 items are based on criteria of the DSM-IV, the revised version of the Diagnostic Interview for Borderline Personality Disorder, and the opinions of both clinical experts and borderline patients. The BSL-95 includes 95 items. In order to reduce patient burden and assessment time, a short version with 23 items (BSL-23) was developed. Methods: The development of the BSL-23 was based on a sample of 379 borderline patients, considering the items from the BSL-95 that had the highest levels of sensitivity to change and the highest ability to discriminate borderline patients from other patient groups. In a second step, the psychometric properties of the BSL-23 were investigated and compared with the psychometric properties of the BSL-95 in 5 different samples, including a total of 659 borderline patients. Results: In all of the samples, a high correlation of the sum score was found between the BSL-23 and the BSL-95 (range: 0.958-0.963). The internal consistency was high for both versions (BSL-23/Cronbach’s alpha: 0.935-0.969; BSL-95/Cronbach’s alpha: 0.977-0.978). Both BSL-23 and BSL-95 clearly discriminated borderline personality disorder patients from patients with an axis I diagnosis (mean effect sizes were 1.13 and 0.96 for the BSL-23 and BSL-95, respectively). In addition, comparisons before and after 3 months of dialectical behavior therapy revealed a numerically larger effect size for the BSL-23 (d = 0.47) compared to the BSL-95 (d = 0.38). Conclusion: The results indicate that the BSL-23 is an efficient and convenient self-rating instrument that displays good psychometric properties comparable to those of the BSL-95. The BSL-23 also demonstrated sensitivity to the effects of therapy.

PMID: 19023232 [PubMed - as supplied by publisher]

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AIDS (acquired immunodeficiency syndrome) is caused by the human immunodeficiency virus, or HIV. By killing or damaging cells of the body’s immune system, HIV progressively destroys the body’s ability to fight infections and certain cancers. These infections are caused by viruses or bacteria that usually do not make healthy people sick.

Many people infected with HIV or living with AIDS may be considering the use of complementary and alternative medicine (CAM) to boost their immune system; treat complications of disease; or cope with side effects of conventional medications.

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[Promoting recovery of schizophrenic patients: discrepancy between routine practice and evidence. The SIEP-DIRECT’S Project]

Epidemiol Psichiatr Soc. 2008 Oct-Dec;17(4):331-48

Authors: Semisa D, Casacchia M, Di Munzio W, Neri G, Buscaglia G, Burti L, Pucci C, Corlito G, Bacigalupi M, Parravani R, Roncone R, Cristofalo D, Lora A, Ruggeri M,

AIMS: The aim of this work is to present the main discrepancies, as evidenced by the SIEP-DIRECT’S Project, between the evidence-based NICE guidelines for schizophrenia and the usual practices of the Italian mental health services in order to promote the recovery of patients with schizophrenia. METHODS: Starting from the main NICE recommendations on recovery promotion, 41 indicators were developed. These were experimented in 19 participating Italian Mental Health Departments (MHD) or Psychiatric Services through self-evaluation of the activities carried out to promote patient recovery with the aim of assessing the level of adherence to the recommendations. The data required by most of the indicators were obtained from the psychiatric informative system or from the Direction of the MHD. Moreover, specific research was carried out on the clinical records and on representative patient samples. Furthermore, for 14 indicators, there was requested an assessment by the part of “multidisciplinary” or “specialistic” focus groups who then attributed a score according to a defined “ad hoc” scale. RESULTS: According to the data obtained, although the mental health services seem to care about the physical condition of their patients, they do not routinely examine principle parameters such as blood pressure, glycaemia etc., and collaboration with general practitioners is often complex or not uniformly practiced. Most psychiatrists and psychologists possess the basic communication skills but not enough competences in cognitive-behavioural treatments; such treatments, and every other form of structured individual psychotherapy, are seldom carried out and seem to have become marginal activities within the Services. Also family psycho-educational interventions are under-used. The Services are very active in the care of multi-problem schizophrenia patients, who make up a large percentage (almost a quarter, on average) of the patients in their care. These patients are offered specific and integrated treatment plans with the involvement of other health services and social agencies operating in the territory. The strategies adopted by the services for the pharmacological treatment in the prevention of relapses and for patients with frequent crises or with treatment-resistant schizophrenia are all in line with the NICE recommendations. Finally, the Services promote activities of vocational training and supported employment, but the outcomes of these are often unsatisfactory. CONCLUSIONS: The results of the study show a picture of the Italian mental health services with bright yet also dark areas as regards recovery promotion activities. The Services seem to guarantee adequate pharmacological evidence-based treatments, an integrated assistance and good management of multi-problem patients. They have difficulty, however, with respect to the monitoring of the physical health of the patients, psychotherapeutic activities, including those for families, and the promotion of supported employment. Moreover, they still show problems regarding the structuring and formalizing of care processes. To improve this situation, they should make greater use of professional guidelines, protocols and written procedures.

PMID: 19024721 [PubMed - in process]

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