Influence of partnership on the outcome of psychotherapy

30 patients who had psychosomatic disorders and were living constantly with the same partner were followed up 2-3 years after inpatient psychotherapy. The outcome of psychotherapy was assessed and the patients were interviewed about partnership and disease. The interviews were evaluated by 10 raters who had to score 26 variables. Using a discriminant analysis 4 variables were selected which predicted outcome correctly in 93.3% of the patients: who leaves whom in case of separation; partner's help in coping with illness guided by patient's needs; cognitive reappraisal of the patient, and changes in the extradyadic relation of the partner. The findings clearly demonstrate that the cognitions on partnership are connected with the outcome of psychotherapy to a substantial degree.     

脉冲光刺激辅助心身疾病治疗的临床研究

以情绪障碍为中心的多种临床表现是心身疾病的基本特征之一,所以在心身疾病的治疗过程中,应该采取心身相结合的综合防治措施。但是,在目前临床实际中,由于受到诸多条件的限制,心理咨询和心理治疗工作,难以普遍开展,致使这类单纯采用生物疗法的心身疾病患者,病程迁延、易反复、不能治愈。本文采用脉冲光刺激仪,通过信息耦合方式,诱导、同化患者的脑电变化,对52例消化系统心身疾病患者进行辅助治疗观察,结果发现使用该技术可以明显改善患者的焦虑、抑郁等情绪障碍,同时消化系统的不适症状也得到了有效的缓解。光刺激诱导治疗心身疾病,是生物反馈理论应用于该领域的新尝试,由于该技术安全、有效、简便、易行,为心身疾病的治疗开辟了广阔的前景。     

Internet use among patients with psychosomatic disorders: what are the health-related demands and needs?

While Internet-based health-related offers for various disorders are increasing, little is known about the way patients with psychosomatic disorders use the Internet. We conducted a questionnaire survey in outpatient clinics at two university hospitals' Departments of Psychosomatic Medicine. Seventy-four percent of N = 274 patients had Internet home access and 60 percent of those patients reported health-related Internet use. Patients expressed the wish for more professional, evidence-based online information and expert-guided treatment. The survey results support the Internet's high potential in future treatment strategies for patients with psychosomatic disorders.     

An evaluation of large group CBT psycho-education for anxiety disorders delivered in routine practice

OBJECTIVE: To determine the clinical utility and acceptability of a brief CBT psycho-educational course delivered in an NHS psychotherapy service. METHODS: All patients referred, found suitable for CBT, and who had an anxiety disorder, were invited to enrol in a psycho-education course, delivered in an outpatient mental health clinic by two mental health nurses with post-registration training in CBT. There were up to 24 patients in each course. Outcome measures used were CORE-OM and Fear Questionnaire administered pre-course and at 12-week follow-up and Client Satisfaction Questionnaire administered post-course. RESULTS: One-hundred and ninety one patients were referred. Of these 120 remained in contact with the service to the follow-up meeting. Ninety-seven patients were discharged at the follow-up point and 92 requested further individual psychotherapy. A number of patients made a clinical and reliable change as measured by CORE-OM and Fear Questionnaire. One-hundred and two patients completed the CSQ-8 reporting high satisfaction with the intervention. CONCLUSIONS: The intervention appears to be helpful for a number of patients and largely acceptable for most patients that attend. PRACTICE IMPLICATIONS: Large group psycho-educational interventions for anxiety disorders could be increasingly used as a method of delivering low intensity treatments within a stepped care model of the treatment of anxiety disorders. The intervention is relatively simple to deliver and potentially could be delivered by primary care clinicians.     

Accuracy of the clinical diagnosis of 'psychogenic disorders' in the presence of physical symptoms suggesting a general medical condition: a 5-year follow-up in 162 patients.

OBJECTIVE: The range of unnoticed physical disorders in patients diagnosed with a psychogenic disorder varies widely. We investigated the accuracy of the clinical diagnosis of 'psychogenic disorder' where physical symptoms suggesting a somatic condition (PDPS) are present. METHOD: All 162 cases of PDPS diagnosed between 01.01.1986 and 31.12.1987 in a medical clinic specializing in psychosomatic medicine were reviewed after 5 years. 148 follow-ups were complete. Initial diagnoses had been established using positive criteria for psychogenic diagnosis in a semistructured interview and a comprehensive clinical workup by trained clinicians. RESULTS: In 2 (1.35%) foreign-language patients of 148 an orthopedic diagnosis had been missed. In 6 patients, the family physician gave formerly known findings a different interpretation. Half of these patients were foreigners; 5 were men; none improved; 5 had back pain. CONCLUSION: A semistructured interview and positive criteria for psychogenic diagnosis permitted high diagnostic accuracy with an error of 1.35% in 148 cases.     

Psychosomatic disorders in children: Structural family therapy

Structural family therapy has proved effective in Severe childhood and adolescent psychosomatic disorders unresponsive to medical management or other forms of psychotherapy. The authors review a psychosomatic research project and the profile of the family that developed from it, and describe how principles of structural family therapy are applied to treatment of childhood psychosomatic disorders.     

Combined inpatient and outpatient group psychotherapy: a therapeutic model for psychosomatics.

A special strategy of psychotherapeutic approach to psychosomatic patients is described including a 3-month period of inpatient and a 2-year period of outpatient group psychotherapy. Additional therapeutic procedures applied during the time of hospitalization are a special kind of sensitivity training ('sensual awareness' -- 'konzentrative Bewegungstherapie') and analytic ergotherapy. The therapeutic techniques used are psychoanalytic with special regard to the scenic figures which arise during the course of a session. The 'scenic function of the ego' represented in, e.g., certain body movements, sitting-arrangments, and talking-sequences offers the opportunity of a possible access to the often poor phantasy life of the psychosomatic patient, suffering from what we call the Pinocchio syndrome. The key structure of the model implies the arrangement fixed prior to the onset of therapy between patients and therapist, to stay together as a closed in- and outpatient group for 2 years. This enables the patients to take the risk of new emotional experiences under the cover of protected living conditions in the hospital, as well as the chance to check and confirm these experiences under the pressure of the regular social conditions they live in.     

Examining the relationship between object relations and interpersonal distress in a clinical sample

The goal of the present study was to explore the relationship between patients' object relational functioning (Social Cognition and Object Relations Scale‐Global Ratings) as rated by clinicians during the course of outpatient psychodynamic psychotherapy in a university‐based clinic and patient self‐reported interpersonal vulnerabilities (Inventory of Interpersonal Problems‐64). Participants (n = 112) were outpatients entering treatment at a university‐based psychotherapy clinic and were diagnosed primarily with mood disorders as well as Axis II relational problems and features. Participants completed the IIP‐64 prior to receiving therapy, and SCORS‐G ratings were based on patients' level of relational functioning during the evaluation process (i.e., the semistructured interview, follow‐up and feedback) and across the first two psychotherapy sessions. Results showed a significant relationship between the IIP‐64 Total score with SCORS‐GSelf‐Esteem (r = ?.21, p < .05) and Affective Quality of Representations (r = ?.20, p < .05), wherein self‐reported interpersonal dysfunction was greater among patients who had lower self‐worth and perceived others as more malevolent. These findings suggest that patients who rated themselves as having more significant interpersonal difficulty reported more negative expectations and experiences of relationships in their psychotherapy narratives. The utility of the SCORS‐G and the IIP‐64 as two different avenues of assessing patient relational functioning is explored.     

Suicidal ideation and attempts in adults seeking outpatient psychodynamic psychotherapy

Suicide is an important cause of death in patients with mental health disorders, but little is known about the occurrence of suicidal ideation and attempts in outpatient psychotherapy patients. The aim of this study was to identify the proportion of patients with and correlates of suicidal ideation and attempts in community-based psychotherapy practices. Using 983 applications for reimbursement of psychotherapy from individual patients, reports about suicidal thoughts and suicide attempts were extracted along with demographic, biographic and clinical data. Multivariate logistic regression analysis was used to identify correlates of suicidal ideation and attempts by calculating odds ratios (ORs). Among the patients, 19% presented with suicidal thoughts (11% currently and 8% in the past) and 6% with suicide attempts. Important correlates of suicidal thoughts were male gender (OR 1.7), lower education (OR 1.8), early retirement (OR 2.9), death of a parent when younger than 5 years old (OR 3.3), violence experienced from various people (OR 2.1), self-harm behaviour (OR 7.9) and alcohol misuse (OR 1.7). Suicide attempts were associated with male gender (OR 5.6), lower education (OR 4.2), violence experienced from partner (OR 2.5) or from various people (OR 9.5) and self-harm behaviour (OR 15.0). These results show that the proportion of suicidal patients seeking outpatient psychotherapy is high. It should therefore be a central topic in clinical training. Biographic data such as the loss of a parent at an early age or experiencing violence are associated with who is at increased risk and should be explored in detail.     

Depression profile in patients with and without chronic heart failure

OBJECTIVE: Depression often goes undetected and untreated in patients with chronic heart failure (CHF). To investigate whether patients with CHF show a specific profile of depression symptoms, we compared depression symptoms in depressed patients with and without CHF. METHODS: Of a total of 921 patients from a CHF and a psychosomatic outpatient clinic, 137 met DSM-IV diagnostic criteria for major depressive disorder and 113 for other depressive disorders. Depressed patients with CHF (n=113) and without CHF (n=137) were compared with respect to severity of individual DSM-IV depressive symptoms, as measured with the PHQ-9. To stratify for depression severity, ANCOVAs with sociodemographic characteristics as covariates were performed separately for patients with major depressive disorder and other depressive disorders. RESULTS: Among the patients meeting the criteria for major depressive disorder, patients with CHF reported significantly lower levels of depressed mood (p=.006) and worthlessness/guilt (p=.019) than patients without CHF. In contrast, no significant group differences were found for any of the other depression symptoms. Group comparisons among the patients with other depressive disorders completely replicated these results (p< or =.001, and p=.04, respectively). LIMITATIONS: Our study population of CHF patients may not be representative for CHF patients recruited in the general population. CONCLUSIONS: The diagnostic features discriminating between depressed patients with and without CHF are the cognitive-emotional symptoms of depression, not the somatic symptoms. This finding may partially explain the low recognition rate of depression in patients with CHF. The different profile of depression symptoms in patients with and without CHF should be considered in diagnosis, treatment and medical education.     

A comparison of dose-response curves in cognitive-behavioral and psychodynamic psychotherapies

Changes in patient- and therapist-rated process items, and patient-rated symptom severity assessed over a maximum of 30 sessions of psychodynamic or cognitive-behavioral psychotherapy were compared in an outpatient mental-health clinic. Patients' ratings in psychodynamic psychotherapy on two of the process items were superior to ratings by patients in cognitive-behavioral therapy, and interactions with time were discovered for an interpersonal item. Comparisons between patients who reported their initial symptom severities as most severe and those with less severe symptoms also were made, with results indicating differential effects of treatment according to perceptions of symptom severity. Interactions between length of stay in treatment and number of sessions also were investigated. Findings indicated that patients benefit from psychotherapy over time and support the usefulness of a contextual model for psychotherapy funding.     

Randomized trial on the effectiveness of long-and short-term psychodynamic psychotherapy and solution-focused therapy on psychiatric symptoms during a 3-year follow-up

BACKGROUND: Insufficient evidence exists for a viable choice between long- and short-term psychotherapies in the treatment of psychiatric disorders. The present trial compares the effectiveness of one long-term therapy and two short-term therapies in the treatment of mood and anxiety disorders. METHOD: In the Helsinki Psychotherapy Study, 326 out-patients with mood (84.7%) or anxiety disorder (43.6%) were randomly assigned to three treatment groups (long-term psychodynamic psychotherapy, short-term psychodynamic psychotherapy, and solution-focused therapy) and were followed up for 3 years from start of treatment. Primary outcome measures were depressive symptoms measured by self-report Beck Depression Inventory (BDI) and observer-rated Hamilton Depression Rating Scale (HAMD), and anxiety symptoms measured by self-report Symptom Check List Anxiety Scale (SCL-90-Anx) and observer-rated Hamilton Anxiety Rating Scale (HAMA). RESULTS: A statistically significant reduction of symptoms was noted for BDI (51%), HAMD (36%), SCL-90-Anx (41%) and HAMA (38%) during the 3-year follow-up. Short-term psychodynamic psychotherapy was more effective than long-term psychodynamic psychotherapy during the first year, showing 15-27% lower scores for the four outcome measures. During the second year of follow-up no significant differences were found between the short-term and long-term therapies, and after 3 years of follow-up long-term psychodynamic psychotherapy was more effective with 14-37% lower scores for the outcome variables. No statistically significant differences were found in the effectiveness of the short-term therapies. CONCLUSIONS: Short-term therapies produce benefits more quickly than long-term psychodynamic psychotherapy but in the long run long-term psychodynamic psychotherapy is superior to short-term therapies. However, more research is needed to determine which patients should be given long-term psychotherapy for the treatment of mood or anxiety disorders.     

Psychosomatic studies of allergic disorders.

It is generally conceded that allergic disorders occur in individuals who have a hereditary or congenital allergic constitution. Clinical symptoms of allergic disorders, however, often disappear due to changes of the individuals' life situations and/or their adaptive patterns. In a comparative study of allergic predisposition in students with allergic disorder (asthmatics) and students who had become completely free from childhood asthma for more than 3 years, without specific treatment, there was no significant difference in allergic predisposition between the two groups. The same tendency was also found between adult patients with allergic disorder (asthmatics) and persons who had shown complete remission for more than 3 years, having had psychosomatic treatment. These findings suggest that allergic predisposition does not influence the prognosis of allergic disorders as much as do socio-psychological factors. It is thought that the effect of psychosomatic treatment reconditions these socio-psychological factors which disturb homeostatic balance and which facilitate the clinical manifestation based on the allergic predisposition.     

Dropout from brief psychotherapy in anorexia nervosa

BACKGROUND: Dropout from psychotherapy is an important issue that has received little systematic attention. This study investigated the phenomenon of dropout from brief psychotherapy for anorexia nervosa (AN). METHODS: 99 outpatients suffering from AN of the restrictor type (n = 53) or binge/purging type (n = 46) were evaluated. Their clinical and personal characteristics were recorded, and body mass index was calculated for participants. They were administered the Eating Disorder Inventory-II (EDI-II), the State-Trait Anger Expression Inventory (STAXI) and the Temperament and Character Inventory (TCI). RESULTS: Significant differences in some baseline psychopathologic (EDI-II, STAXI) and personality (TCI) variables emerged from the comparison between dropouts and completers. Patients who dropped out of the treatment showed higher levels of anger temperament, anger expression-in and expression-out and lower scores for the dimensions of character (low self-directedness and low cooperativeness). No differences were found between the two groups regarding sociodemographic and clinical variables. CONCLUSIONS: Dropout from brief psychotherapy seems to be related to either psychopathologic or personality aspects, such as the tendency to repress anger, which is encountered also in psychosomatic disorders, and the presence of more compromised dimensions of character, typical of subjects with personality disorders. This study of dropout from brief psychotherapy in AN provided interesting results that will need further confirmation. Possible implications for treatment are addressed.     

中学生在综合医院心理门诊就诊分析

目的 了解到综合医院心理门诊就诊中学生情况.方法 对36例门诊病历进行统计分析.结果 36例咨客中有重性精神障碍5例(13.89%),轻性精神障碍25例(69.44%),心理问题34例(94.44%).结论 来咨询的中学生以轻性障碍居多,心理问题涉及范围广.心理治疗或心理记录联合药物治疗有效.     

Development and function of a psychiatric liaison clinic

The author explains the rationale behind the formation of an outpatient psychiatric liaison clinic at Boston City Hospital, describes the services provided there, and reviews the clinic's first year of operation. The clinic is an outgrowth of a consultation-liaison service and it integrates consultation and liaison functions within a clinic setting. It provides diagnostic evaluation and treatment of a wide range of psychosomatic disorders within the context of active liaison with the medical staff, and adds an important dimension to the research and educational needs of the traditional consultation-liaison service.     

Persistent psychological distress in patients treated for endocrine disease

BACKGROUND: The purpose of the study was to assess the frequency and characteristics of psychological distress, even after adequate treatment, in the heterogeneous population of an endocrine outpatient clinic. METHODS: 146 endocrine patients (31 males/115 females; age 39.4 +/- 12.5 years), who were cured or in remission, were studied in a university endocrine outpatient clinic. Semistructured clinical interviews to assess psychiatric (Structured Clinical Interview for DSM-IV) and psychological (Diagnostic Criteria for Psychosomatic Research, DCPR) diagnoses were employed and were supplemented by self-rated instruments (the Psychosocial Index and the Medical Outcome Study short form General Health Survey) which could provide the patients' perception of their own quality of life. RESULTS: There were 118 patients (81%) who presented with at least 1 psychiatric (DSM-IV) or psychological (DCPR) diagnosis. The most frequent diagnostic findings were generalized anxiety disorder (29%), major depression (26%), irritable mood (46%), demoralization (34%) and persistent somatization (21%). By self-rated instruments, patients with at least 1 DSM-IV or DCPR diagnosis reported significantly more stressful life circumstances, psychological distress and an impaired quality of life compared to those who had none. CONCLUSIONS: A high prevalence of psychological distress may be encountered in the long-term follow-up of endocrine patients. A biopsychosocial consideration of the person and his/her quality of life appears to be mandatory for improving therapeutic effectiveness in endocrine disorders.     

Allergic rhinitis in children with attention-deficit/hyperactivity disorder.

BACKGROUND: Both allergic rhinitis and attention-deficit/hyperactivity disorder (ADHD) are common pediatric conditions associated with learning difficulties and sleep disturbances. There are conflicting research data regarding the association between ADHD and atopic disorders. OBJECTIVE: To determine the prevalence of allergic rhinitis in patients with physician-diagnosed ADHD. METHODS: Patients 5 to 18 years of age who presented with a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnosis of ADHD to an outpatient pediatric psychiatry clinic were screened for allergic rhinitis with focused history, physical examination, and skin prick testing to common aeroallergens. RESULTS: Thirty patients were interviewed, with 23 of these undergoing physical examination and skin prick testing. Eighty percent reported allergic rhinitis symptoms, whereas 61% had at least 1 positive prick skin test result. Forty-three percent showed typical physical signs of allergic rhinitis, 100% had a positive atopic family history, and 53% had other associated atopic disorders. CONCLUSIONS: Most children with ADHD displayed symptoms and skin prick test results consistent with allergic rhinitis. Nasal obstruction and other symptoms of allergic rhinitis could explain some of the cognitive patterns observed in ADHD, which might result from sleep disturbance known to occur with allergic rhinitis. Therefore, evaluation and treatment of allergic rhinitis could benefit patients with ADHD.     

Clinical Characteristics and Referral Patterns of Outpatients Visiting a Japanese Psychosomatic Medicine Clinic

Background

The definition of psychosomatic medicine is not consistent across countries.

Purpose

The study purpose was to clarify the applicability of the definition of psychosomatic illness issued by the Japanese Society of Psychosomatic Medicine to different types of referral in a university hospital.

Methods

The sample consisted of 1067 outpatients visiting a psychosomatic clinic. Participants completed questionnaires to assess degrees of somatization, depression, anxiety, and psychosocial stress after completing clinical interviews based on the Diagnostic and Statistical Manual, Fourth Edition, Text Revision. All subjects were classified into psychosomatic and non-psychosomatic groups, and the non-psychosomatic group was further divided into three additional groups: depression, anxiety, and other.

Results

In total, 398 (37 %) of the subjects were placed in the psychosomatic group. The percentage of the psychosomatic group was 46 % in those referred within the hospital, 37 % in those referred outside the hospital, and 28 % in those without referral from physicians. Concerning the non-psychosomatic group, 269 (25 %) were placed in the depression group, 229 (22 %) in the anxiety group, and 171 (16 %) in the other group. Membership in the psychosomatic group was positively associated with age and the severity of somatosensory amplification (both p?<?0.05), but negatively associated with the severity of depression and anxiety as well as the classification of non-referral (all p?<?0.05).

Conclusions

Although patients with psychiatric disorders, including depressive and anxiety disorders, are frequently seen in the Japanese psychosomatic clinic, patients who are diagnosed with psychosomatic illnesses tend to have been referred by physicians within the hospital. The concept of psychosomatic medicine needs to be further developed to assist both clinical practitioners and patients.

     

A 4-year follow-up study of in-patient psychosomatic patients.

The subjects of the inquiry were 13 psychosomatic patients who had all undergone psychotherapy in the special research unit of the University Clinic for Psychosomatics in Giessen (FRG) in 1971. Data collection took place at the beginning (time a) and end (time b) of in-patient treatment, and then again 4 years later (time c). The same test battery was administered each time. The results indicate that a significant change in the patients' self-image came about during in-patient treatment and the catamnesis carried out 4 years later attests to the stability of this development. The question of whether this change reflects the patient's adjustment to the ideals of his therapist--conformity with the 'norm'--or can be interpreted as a criterium for true ego development in the sense of an expansion of his psychic possibilities, is discussed.