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Does Interpersonal Loss Preceding Panic Disorder Onset Moderate Response to Psychotherapy? An Exploratory Study.

J Clin Psychiatry. 2008 Nov 24;

Authors: Klass ET, Milrod BL, Leon AC, Kay SJ, Schwalberg M, Li C, Markowitz JC

BACKGROUND: Little research has addressed moderators of treatment outcome for anxiety disorders, and none has considered interpersonal loss as a predictor of outcome. PURPOSE: To examine the effect of interpersonal loss events within the 6 weeks preceding panic disorder onset as a moderator of outcome in a randomized controlled trial of Panic-Focused Psychodynamic Therapy (PFPP) and Applied Relaxation Therapy (ART). Researchers hypothesized that such loss events would predict better outcome in PFPP but would not affect ART outcome. METHOD: Forty-nine subjects with panic disorder were randomly assigned to a 12-week course of PFPP or ART. Independent raters blinded to treatment condition and study hypotheses rated subjects on the Panic Disorder Severity Scale (PDSS) and Sheehan Disability Scale. Exploratory analyses assessed between-group effect size for PFPP and ART following standard moderator analytic procedures. The trial was conducted between February 2000 and January 2005. RESULTS: Three quarters of subjects reported a narrowly defined interpersonal loss (LOSS) in the 6 weeks preceding panic disorder onset. These subjects had a mean (SD) duration of panic disorder of 8.2 (9.5) years. PFPP was more efficacious than ART, but LOSS did not moderate PFPP outcome. An unexpected finding was that LOSS moderated ART outcome: subjects without LOSS showed no response to ART (PDSS mean (SD) change score = 0.00 [2.90]), whereas LOSS had a pre-post mean (SD) change score of 4.29 (5.60). Neither examination of potential confounding variables nor sensitivity analyses of assumptions regarding attrition altered these findings. CONCLUSIONS: Interpersonal loss events preceding onset of panic disorder were more common even than in prior studies. These losses moderated outcome in ART, a therapy that does not focus on such losses. Implications and the need for future research before incorporating these findings into clinical practice are discussed.

PMID: 19026262 [PubMed - as supplied by publisher]

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Multinational Study of Cancer Patients and Their Children: Factors Associated With Family Functioning.

J Clin Oncol. 2008 Nov 24;

Authors: Schmitt F, Piha J, Helenius H, Baldus C, Kienbacher C, Steck B, Thastum M, Watson M, Romer G

PURPOSE: This study examined factors associated with family functioning in cancer patients’ families with dependent children. PATIENTS AND METHODS: A sample of 381 families (639 parents and 489 children) was recruited simultaneously in six European countries. Patients and family members completed a background questionnaire, the Family Assessment Device (FAD), the Beck Depression Inventory, and the short form version of the Medical Outcomes Health Survey. Descriptive statistics and a multilevel model that allowed a multi-informant design were used. Analyses were carried out with all participants, and separately with parent-rated and children-rated FAD scores. RESULTS: In descriptive analyses, children reported more impairment in family functioning than parents, but the difference was not significant. Depression prevalence was 35% for ill mothers and 28% for ill fathers. In the multilevel analyses with all participants (ie, adults and children) the ill parent’s depression was significantly associated with impaired family functioning on five of seven FAD subscales. In analyses with only children, the perception of impairment of family functioning was not associated with parental depression. Additionally, poorer physical status of the ill parent was significantly associated with impairment on roles and communication. CONCLUSION: The ill parent’s depression was the most significant factor associated with impairment in family functioning. Screening for depression, active diagnostics, and appropriate treatment of cancer patient’s and partner’s depression may be important to protect their children from mental disorders. Therefore, support systems need to be more family-oriented and child-centered in their approaches to cancer psychosocial care.

PMID: 19029426 [PubMed - as supplied by publisher]

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Bright Light Therapy.

Neuro Endocrinol Lett. 2008 Nov 23;29(Suppl1)

Authors: Prasko J

Bright light is a treatment of choice for seasonal affective disorder. Other indications for bright light therapy have also been tested. These include non-seasonal depression, bipolar depression, chronic depressive disorder, ante- and postpartum depression, late luteal phase dysphoric disorder, circadian phase sleep disorders, jet lag, shift work problems, and behavioral disturbance and insomnia in organic dementia. Future studies should focus on exploring the use of light therapy in combination with sleep deprivation, other classes of antidepressants, and with psychotherapy and their possible combined effect on subtypes of depression or other mentioned diagnoses, light treatment duration, and the applicability and efficacy of adjunct light treatment for in-patients.

PMID: 19029878 [PubMed - as supplied by publisher]

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The Ottawa summit: new training parameters for child and adolescent psychiatry at the university of Ottawa.

Can Child Adolesc Psychiatr Rev. 2003 Nov;12(4):107-9

Authors: Puddester D, Goulard G, Gray C

OBJECTIVE: To develop a renewed and innovative curricula for training and education in child and adolescent psychiatry career for track psychiatry trainees at the University of Ottawa. METHOD: Faculty members who were graduates of multiple Canadian training programs, as well as current career child psychiatry trainees of the University of Ottawa program, summarized and reviewed their training and education experiences in a one day summit. This was integrated into overall directions cited by recent literature as well as positions of the Canadian Academy of Child and Adolescent Psychiatry. RESULTS: A template for new curricula was developed with new focus being placed on normal development, research methodology/evidence based medicine, emergency psychiatry, psychotherapy, and cultural competence. CONCLUSIONS: Curricula renewal is essential, possible, and appropriate in order to produce a Child and Adolescent Psychiatrist who meets the needs of the Canadian public as defined in the CanMeds 2000 project of the RCPSC.

PMID: 19030152 [PubMed - in process]

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Child and parent variables associated with treatment response in narcissistic youths: the role of self-blame and shame.

Can Child Adolesc Psychiatr Rev. 2004 Aug;13(3):81-5

Authors: Guilé JM, Mbékou V, Lageix P

INTRODUCTION: this retrospective study aimed at exploring the impact of parental and youth narcissism on service utilization and response to psychotherapy. METHOD: thirty-six 9-13 years-old narcissistic youths receiving a combined treatment (psychodynamic psychotherapy + parental counselling) were independently assessed for child pathological narcissism, parental narcissism, child’s treatment attitude and psychiatric/ psychosocial services utilization. RESULTS: Parent and child narcissistic characteristics were negatively correlated with the use of OPD services. Child self-blame and lack of empathy predicted a lesser OPD utilization. Child pathological narcissism was significantly correlated with the specific treatment response pattern composed of the set of attitudes consistently observed in psychotherapy with narcissistic youths. Sixty percent of the variance in treatment response was accounted for by four narcissistic characteristics of the child: devaluation of others, avoidance of vulnerability, boredom, and self-blame. Post hoc analyses highlighted the role of the child’s self-blame, which mediated the relation between parental narcissism and service use while acting as a moderator in reversing the relation between parent narcissism and treatment response. Relationships between self-blame, shame-proneness and guilt, and limitations of the study are discussed. CONCLUSION: Prospective studies with a larger sample are needed to confirm the association between self-blame and response to treatment in narcissistic youths.

PMID: 19030505 [PubMed - in process]

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Psychotherapy versus the combination of psychotherapy and pharmacotherapy in the treatment of depression: a meta-analysis.

Depress Anxiety. 2008 Nov 21;

Authors: Cuijpers P, van Straten A, Warmerdam L, Andersson G

Background: A large number of studies have shown that psychological treatments have significant effects on depression. Although several studies have examined the relative effects of psychological and combined treatments, this has not been studied satisfactorily in recent statistical meta-analyses. Method: We conducted a meta-analysis of randomized studies in which a psychological treatment was compared to a combined treatment consisting of the same psychological treatment with a pharmacological therapy. For each of these studies we calculated the effect size indicating the difference between the psychological and the combined treatment. Results: All inclusion criteria were met by 18 studies, with a total of 1,838 subjects. The mean effect size indicating the difference between psychological and combined treatment was 0.35 (95% CI: 0.24 approximately 0.45; P<0.001), with low heterogeneity. Subgroup analyses indicated that the difference between psychological and combined treatments was significantly smaller in studies in which cognitive behavior therapy was examined. We also found a trend (P<0.1) indicating that the difference between psychological and combined treatment was somewhat larger in studies aimed at specific populations (older adults, chronic depression, HIV patients) than in studies with adults, and in studies in which Trycyclic antidepressants or SSRIs were examined, compared to studies in which a medication protocol or another antidepressant was used. At follow-up, no difference between psychological and combined treatments was found. Conclusion: We conclude that combined treatment is more effective than psychological treatment alone. However, it is not clear whether this difference is relevant from a clinical perspective. Depression and Anxiety 0:1-10, 2008. (c) 2008 Wiley-Liss, Inc.

PMID: 19031487 [PubMed - as supplied by publisher]

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Related Articles

A randomized clinical trial for women with vulvodynia: Cognitive-behavioral therapy vs. supportive psychotherapy.

Pain. 2008 Nov 18;

Authors: Masheb RM, Kerns RD, Lozano C, Minkin MJ, Richman S

Many treatments used for women with vulvodynia are based solely upon expert opinion. This randomized trial aimed to test the relative efficacy of cognitive-behavioral therapy (CBT) and supportive psychotherapy (SPT) in women with vulvodynia. Of the 50 participants, 42 (84%) completed 10-week treatments and 47 (94%) completed one-year follow-up assessments. Mixed effects modeling was used to make use of all available data. Participants had statistically significant decreases in pain severity (p’s<0.001) with 42% of the overall sample achieving clinical improvement. CBT, relative to SPT, resulted in significantly greater improvement in pain severity during physician examination (p=0.014), and greater improvement in sexual function (p=0.034), from pre- to post-treatment. Treatment effects were well maintained at one-year follow-up in both groups. Participants in the CBT condition reported significantly greater treatment improvement, satisfaction and credibility than participants in the SPT condition (p’s<0.05). Findings from the present study suggest that psychosocial treatments for vulvodynia are effective. CBT, a directed treatment approach that involves learning and practice of specific pain-relevant coping and self-management skills, yielded better outcomes and greater patient satisfaction than a less directive approach.

PMID: 19022580 [PubMed - as supplied by publisher]

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Related Articles

Psychiatric disorders among infertile and fertile women.

Soc Psychiatry Psychiatr Epidemiol. 2008 Nov 20;

Authors: Noorbala AA, Ramezanzadeh F, Abedinia N, Naghizadeh MM

This study was performed in order to determine the prevalence and predisposing factors of psychiatric disorders among infertile and fertile women attending Vali-e-Asr Hospital. A total of 150 fertile women from Vali-e-Asr Reproduction Health Research Center and fertile women from the Gynecology Clinic of Imam Khomeini Hospital were chosen by consecutive sampling. Data included demographic information, SCL-90-R, and a semi-structured questionnaire about stress factors. Results showed that 44% of infertile and 28.7% of fertile women had a psychiatric disorder (P < 0.001). Using the SCL-90-R test, the highest mean scores in infertile women were found to be on the paranoid ideation, depression and interpersonal sensitivity scales, and lowest scores were found on the psychoticism and phobic anxiety scales. The interpersonal sensitivity, depression, phobic anxiety, paranoid ideas and psychoticism scales were significantly different between infertile and fertile women (P < 0.05). Infertile women were at higher risk of developing psychiatric disorders if they were housewives rather than working women (P = 0.001). Considering the high prevalence of psychiatric disorders among infertile women, it seems that gynecologists, psychiatrists and psychologists should be more attentive to identify and treat these disorders. The use of psychotherapy, especially supportive methods, should be considered as part of the general therapeutic framework of infertility.

PMID: 19023508 [PubMed - as supplied by publisher]

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Related Articles

Effect of mind on brain activity: Evidence from neuroimaging studies of psychotherapy and placebo effect.

Nord J Psychiatry. 2008 Nov 20;:1-12

Authors: Beauregard M

Mentalistic variables must be considered to reach a correct understanding of the neurophysiological basis of behavior in humans. Confusion regarding the relative importance of neurophysiological and mentalistic variables can lead to important misconceptions about causes and effects in the study of human behavior. In this article, we review neuroimaging studies of the effect of psychotherapy in patients suffering from diverse forms of psychopathology (obsessive-compulsive disorder, panic disorder, unipolar major depressive disorder, spider phobia). We also review neuroimaging studies of the placebo effect in healthy individuals (placebo analgesia, psychostimulant expectation) and patients with Parkinson’s disease or unipolar major depressive disorder. Mental functions and processes involved in diverse forms of psychotherapy exert a significant influence on brain activity. With regard to the placebo effect, beliefs and expectations can markedly modulate neurophysiological and neurochemical activity in brain regions involved in perception, movement, pain and various aspects of emotion processing. The findings of the neuroimaging studies reviewed here strongly support the view that the subjective nature and the intentional content of mental processes significantly influence the various levels of brain functioning (e.g. molecular, cellular, neural circuit) and brain plasticity.

PMID: 19023697 [PubMed - as supplied by publisher]

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Therapists’ Attitudes Towards Psychotherapeutic Strategies in Community-Based Psychotherapy with Children with Disruptive Behavior Problems.

Adm Policy Ment Health. 2008 Nov 19;

Authors: Brookman-Frazee L, Garland AF, Taylor R, Zoffness R

Little is known about what individual treatment strategies therapists providing usual care psychotherapy consider the most valuable to their practice. The Therapeutic Strategies Survey (TSS) assesses therapists’ attitudes about the value of 27 individual treatment strategies in their practice with children with disruptive behavior problems in community-based outpatient psychotherapy. Findings indicate that therapists from multiple professional disciplines highly value many individual psychotherapeutic strategies, and consider strategies common to a majority of evidence-based practices (EBPs) for this population at least as important as strategies not emphasized in EBPs. Implications for developing therapist training and implementation of EBPs are discussed.

PMID: 19016320 [PubMed - as supplied by publisher]

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