Clinical practice guideline for accurate diagnosis and effective treatment of gastrointestinal stromal tumor in Korea

Despite the rarity in incidence and prevalence, gastrointestinal stromal tumor (GIST) has emerged as a distinct pathogenetic entity. And the clinical management of GIST has been evolving very rapidly due to the recent recognition of its oncogenic signal transduction pathway and the introduction of new molecular-targeted therapy. Successful management of GIST requires a multidisciplinary approach firmly based on accurate histopathologic diagnosis. However, there was no standardized guideline for the management of Korean GIST patients. In 2007, the Korean GIST study group (KGSG) published the first guideline for optimal diagnosis and treatment of GIST in Korea. As the second version of the guideline, we herein have updated recent clinical recommendations and reflected changes in diagnosis, surgical and medical treatments for more optimal clinical practice for GIST in Korea. We hope the guideline can be of help in enhancing the quality of diagnosis by members of the Korean associate of physicians involving in GIST patients's care and subsequently in achieving optimal efficacy of treatment.     

Evidence-Based,Pharmacological Treatment Guideline for Depression in Korea,Revised Edition

This paper aims to introduce, summarize, and emphasize the importance of the ''Evidence-Based, Pharmacological Treatment Guideline for Depression in Korea, Revised Edition''. The guideline broadly covers most aspects of the pharmacological treatment of patients in Korea diagnosed with moderate to severe major depression according to the DSM-IV TR. The guideline establishment process involved determining and answering a number of key questions, searching and selecting publications, evaluating recommendations, preparing guideline drafts, undergoing external expert reviews, and obtaining approval. A guideline adaptation process was conducted for the revised edition. The guideline strongly recommends pharmacological treatment considered appropriate to the current clinical situation in Korea, and should be considered helpful when selecting the appropriate pharmacological treatment of patients diagnosed with major depressive disorder. Therefore, the wide distribution of this guideline is recommended.     

Introduction to the special section on cognitive processes and psychotherapy

Theoretical models featuring cognitive processes have played a fundamental role in advancing knowledge of psychopathology and its treatment and have emphasized the importance of cognition in psychotherapy. Recognition of the importance of cognition in psychotherapy has led to a number of questions that are addressed by the articles in this special section of the Journal of Consulting and Clinical Psychology. Cognitive therapy is well represented in the articles in this special section, but therapeutic procedures that do not represent typical cognitive therapy are also examined. The articles in this special section focus on homework in the modification of cognition, cognition in the treatment of anxiety in adults and in children, change in depressive cognitions in children, cognition and rapid change in the treatment of depression, and the role of cognition in the treatment and prevention of depression that is recurrent. Examination of these types of questions holds the possibility of advances in existing treatments and the possibility of innovations in new treatments.     

Group cognitive behaviour therapy for adults with Asperger syndrome and anxiety or mood disorder: a case series

Individuals with Asperger syndrome are at increased risk for mental health problems compared with the general population, especially with regard to mood and anxiety disorders. Generic mental health services are often ill‐equipped to offer psychotherapeutic treatments to this population, and specialized supports are difficult to find. This case series used a manualized cognitive behaviour therapy group programme (Mind Over Mood) with three adults diagnosed with Asperger syndrome, who were each unable to access psychotherapy through mainstream mental health services. This review highlights the benefits of a cognitive behaviour therapy (CBT) group approach for adults with Asperger syndrome and suggests some potential modifications to traditional CBT provision. Copyright © 2010 John Wiley & Sons, Ltd. Key Practitioner Message: ? As a group, adults with Asperger syndrome are at high risk for anxiety disorders and depression. ? Cognitive behaviour therapy can be adapted to help adults with Asperger syndrome cope with anxiety or depression. ? Group cognitive behaviour therapy for adults with Asperger syndrome may hold a number of advantages to individual therapy.     

Self-administered treatments for depression: a review

Although there are numerous self-help books for depression, relatively few have been empirically tested. However, those that have been used in clinical trials have fared well, with an average effect size roughly equivalent to the average effect size obtained in psychotherapy studies. Computer-based treatments are being developed and appear promising as an alternative to bibliotherapy for those interested in self-administered treatments. This article provides a summary of the depression bibliotherapy literature and discusses several remaining questions such as effectiveness versus efficacy, practice applications, ethics, and future research.     

Is therapist alliance or whole group cohesion more influential in group psychotherapy outcomes?

This study examined the differential ability of early in treatment measures of therapeutic alliance (Working Alliance Inventory), group cohesion (California Psychotherapy Alliance Scale for Group) and group climate (Group Climate Questionnaire) to predict outcome in a 16‐session dynamic group psychotherapy for adults with major depression. Six successful therapy groups with 30 patients receiving psychodynamic group therapy were studied. Patient perceptions of the therapist alliance was not related to outcome, however, perceptions of levels of conflict and group members' ability to work actively and purposefully in treatment did predict outcome. Future research should further investigate how patients' perceptions of the whole group influence their clinical improvement. Copyright © 2008 John Wiley & Sons, Ltd.     

Comparison of Korean COPD Guideline and GOLD Initiative Report in Term of Acute Exacerbation: A Validation Study for Korean COPD Guideline

The purpose of this study was to compare the Korean COPD guideline to GOLD consensus report in terms of acute exacerbation. A total of 361 patients were enrolled in this study, and 16.9% of them experienced acute exacerbation during the follow-up. A total of 6.3% of patients in GOLD A, 9.5% in GOLD B, 7.7% in GOLD C and 17.0% of GOLD D experienced exacerbation during the first year of follow-up, respectively (P=0.09). There was no one who experienced exacerbation during the first year of follow-up in the Korean group ''ga''. The 12-month exacerbation rates of Korean group ''na'' and ''da'' were 4.5% and 16.0%, respectively (P<0.001). We explore the experience of exacerbation in patients with change of their risk group after applying Korean COPD guideline. A total of 16.0% of the patients who were reclassified from GOLD A to Korean group ''da'' experienced acute exacerbation,and 15.3% from GOLD B to Korean group ''da'' experienced acute exacerbation. In summary, the Korean COPD guideline is useful to differentiate the high risk from low risk for exacerbation in terms of spirometry. This indicates that application of Korean COPD guideline is appropriate to treat Korean COPD patients.     

An empirical review of cognitive therapy for late life depression: does research evidence suggest adaptations are necessary for cognitive therapy with older adults?

This paper describes the treatment of depression in older adults using cognitive behaviour therapy (CBT) as first developed by Beck and colleagues. Evidence for the validity and effectiveness of this form of treatment is considered by reference to published outcome research and meta‐analysis studies. Attempts to compare CBT approaches with other forms of psychotherapy have indicated minimal differences in outcome with all therapy modalities reporting beneficial effects in comparison to no treatment or placebo. It is clear that an empirical evaluation of cognitive‐behaviour therapy for late life depression is still in its early stages as evidenced by the small number of published studies. The clinical issue of whether therapeutic adaptations are necessary in order for cognitive therapy to be effective with older adults is briefly discussed with reference to the literature from outcome research. Copyright © 2001 John Wiley & Sons, Ltd.     

Which clinical practice guidelines for depression? An overview for busy practitioners.

BACKGROUND: Many policy and research documents on the treatment of depression in primary care suggest that general practitioners (GPs) should make use of clinical guidelines. AIM: To describe the content of peer-reviewed guidelines for the detection and treatment of depression in primary care and help GPs identify the one most useful to their own needs. METHOD: Guidelines were evaluated by an explicit method using the Institute of Medicine assessment instrument and according to six key clinical management questions identified as important by GPs and psychiatrists. RESULTS: Only five (30%) of the published guidelines identified met all the pre-defined inclusion criteria. Total scores for development process and content ranged from 54% to 82%. Validity scores ranged from 52% to 88%. No guideline answered all the key questions identified by clinicians. CONCLUSIONS: Only two guidelines conform to the quality standard of a clinical practice guideline. One covers all aspects of detection and management of depression in primary care but gives no advice on first-line choice of antidepressant, while the other focuses only on medication and fails to explore problems of case detection or to consider non-pharmacological treatments. However, taken together they do cover most of the key clinical issues in a reliable and valid manner. The identified guidelines vary considerably in both utility and clinical applicability.     

What Is the Optimal Treatment of Mood and Anxiety Disorders?

In clinical psychiatry, the underlying assumption of using an integrated approach (pharmacotherapy + psychotherapy) is that of an additive model of interaction between pharmacotherapy and psychotherapy, which could take place on the basis of specific changes to be induced by specific treatments. However, the simultaneous administration of pharmacotherapy and psychotherapy is based on a cross-sectional, flat view of the disorders which ignores their longitudinal development. An alternative way of integrating pharmacotherapy and psychotherapy involves their sequential administration. In clinical psychiatry, administration of treatment in sequential order has been mainly limited to instances of treatment resistance and involved different types of drugs, such as in drug-refractory depression. This type of sequential approaches, however, was not targeted to the stages of illness or particularly to residual symptoms. In this paper we describe the development of a sequential strategy based on the use of pharmacotherapy in the acute phase of depression and cognitive therapy in its residual phase. The sequential model introduces a conceptual shift in therapeutic practice. It may also involve the use of pharmacotherapy after psychological treatment, the sequential use of two psychotherapeutic techniques, and two pharmacological strategies. We will discuss the implications of the sequential model and some related issues which have clinical value.     

A controlled trial of personal construct psychotherapy for deliberate self‐harm

Evidence for the effectiveness of psychological therapies for people who self‐harm is limited. Personal construct theory provides a model of self‐harm and a framework for therapeutic intervention, which was evaluated in the present study. Sixty‐four adults presenting to Accident and Emergency departments following self‐harm were allocated to a personal construct psychotherapy or a ‘normal clinical practice’ condition. They completed various measures at assessment points pre‐ and post‐therapy. Repetition of self‐harm was assessed over a 3‐year period. Participants in the intervention condition showed significantly greater reduction in suicidal ideation, hopelessness and depression post‐treatment than the control group; and significantly more reconstruing at this point and 6‐month follow‐up. There was some evidence suggestive of a lower frequency of repetition of self‐harm in the intervention than in the control group. It is concluded that brief personal construct psychotherapy may be effective for people who self‐harm and merits further exploration.     

Recent developments in the psychotherapy of depression

The effectiveness of several types of psychotherapy for ambulatory, nonpsychotic depressed patients has been demonstrated in controlled clinical studies. Psychotherapy combined with antidepressant drug treatment appears to be the most effective form of treatment for most outpatients with major depression, although either treatment alone can be effective for patients who will not accept both. There is no evidence for negative interactions between psychotherapy and drug treatment. Interpersonal psychotherapy, cognitive therapy, and intensive psychodynamic cognitive therapy are types of individual psychotherapy that appear to have particular relevance for depression.     

Training and development of psychotherapy in Korea

In this paper, the author presented the assimilation and development of Western psychotherapy in Korea in their historical perspectives since the introduction of Western psychoanalysis and dynamic psychotherapy to Korean cultural soil. The author also described in detail the present status of psychotherapy training in Korea. The philosophical goal of training and development of Korean psychotherapy has been and will be to unify and integrate Western psychotherapy and traditional Eastern Tao (Confucianism, Buddhism and Taoism) which, the author believes, is the highest form of psychotherapy.     

Guidelines for the diagnosis,treatment, prevention and control of infections caused by carbapenem-resistant gram-negative bacilli

The dissemination of carbapenem-resistant Gram-negative bacilli (CRGNB) is a global public health issue. CRGNB isolates are usually extensively drug-resistant or pandrug-resistant, resulting in limited antimicrobial treatment options and high mortality. A multidisciplinary guideline development group covering clinical infectious diseases, clinical microbiology, clinical pharmacology, infection control, and guideline methodology experts jointly developed the present clinical practice guidelines based on best available scientific evidence to address the clinical issues regarding laboratory testing, antimicrobial therapy, and prevention of CRGNB infections. This guideline focuses on carbapenem-resistant Enterobacteriales (CRE), carbapenem-resistant Acinetobacter baumannii (CRAB), and carbapenem-resistant Pseudomonas aeruginosa (CRPA). Sixteen clinical questions were proposed from the perspective of current clinical practice and translated into research questions using PICO (population, intervention, comparator, and outcomes) format to collect and synthesize relevant evidence to inform corresponding recommendations. The grading of recommendations, assessment, development and evaluation (GRADE) approach was used to evaluate the quality of evidence, benefit and risk profile of corresponding interventions and formulate recommendations or suggestions. Evidence extracted from systematic reviews and randomized controlled trials (RCTs) was considered preferentially for treatment-related clinical questions. Observational studies, non-controlled studies, and expert opinions were considered as supplementary evidence in the absence of RCTs. The strength of recommendations was classified as strong or conditional (weak). The evidence informing recommendations derives from studies worldwide, while the implementation suggestions combined the Chinese experience. The target audience of this guideline is clinician and related professionals involved in management of infectious diseases.     

Psychotherapists Collect Data During Routine Clinical Work That Can Contribute to Knowledge About Mechanisms of Change in Psychotherapy

Therapists providing psychological treatments routinely pose and test hypotheses about mechanisms of change, including mechanisms of change in cognitive therapy for depression. When they use systematic, objective, and scientific methods to do these tasks, clinicians can simultaneously provide quality care and contribute to the field's understanding of the mechanisms of therapeutic action. This article presents evidence supporting these assertions and offers examples of data collected in routine clinical practice that answer important questions about the process of change in cognitive therapy for depression.     

Clients' reasons for terminating psychotherapy: A quantitative and qualitative inquiry

Objective. To study private‐practice clients' perspective on reasons for psychotherapy termination and how these are related to demographic and treatment variables and to satisfaction with therapy. Design. Eighty‐four persons who had been in extended private‐practice psychotherapy which ended in the preceding three years participated in the study. Mean number of months in treatment was 27.70 (SD =18.70). Method. Assessment included rating scales and open‐ended questions assessing demographic variables, reasons for terminating therapy, and satisfaction with therapy. Results. Quantitative results revealed that the most frequent reasons for termination were accomplishment of goals, circumstantial constraints and dissatisfaction with therapy, and that client satisfaction was positively related to positive reasons for termination. Qualitative results revealed two additional frequently mentioned reasons for termination: the client's need for independence and the client's involvement in new meaningful relationships. Conclusions. Findings suggest that psychotherapy termination may at times be required to facilitate the pursuit of personally meaningful goals.     

The Current Situation of Treatment Systems for Alcoholism in Korea

Alcoholism is becoming one of the most serious issues in Korea. The purpose of this review article was to understand the present status of the treatment system for alcoholism in Korea compared to the United States and to suggest its developmental direction in Korea. Current modalities of alcoholism treatment in Korea including withdrawal treatment, pharmacotherapy, and psychosocial treatment are available according to Korean evidence-based treatment guidelines. Benzodiazepines and supportive care including vitamin and nutritional support are mainly used to treat alcohol withdrawal in Korea. Naltrexone and acamprosate are the drugs of first choice to treat chronic alcoholism. Psychosocial treatment methods such as individual psychotherapy, group psychotherapy, family therapy, cognitive behavior therapy, cue exposure therapy, 12-step facilitation therapy, self-help group therapy, and community-based treatment have been carried out to treat chronic alcoholism in Korea. However, current alcohol treatment system in Korea is not integrative compared to that in the United States. To establish the treatment system, it is important to set up an independent governmental administration on alcohol abuse, to secure experts on alcoholism, and to conduct outpatient alcoholism treatment programs and facilities in an open system including some form of continuing care.     

Practice parameters for the psychological and behavioral treatment of insomnia: an update. An american academy of sleep medicine report

Insomnia is highly prevalent, has associated daytime consequences which impair job performance and quality of life, and is associated with increased risk of comorbidities including depression. These practice parameters provide recommendations regarding behavioral and psychological treatment approaches, which are often effective in primary and secondary insomnia. These recommendations replace or modify those published in the 1999 practice parameter paper produced by the American Sleep Disorders Association. A Task Force of content experts was appointed by the American Academy of Sleep Medicine to perform a comprehensive review of the scientific literature since 1999 and to grade the evidence regarding non-pharmacological treatments of insomnia. Recommendations were developed based on this review using evidence-based methods. These recommendations were developed by the Standards of Practice Committee and reviewed and approved by the Board of Directors of the American Academy of Sleep Medicine. Psychological and behavioral interventions are effective in the treatment of both chronic primary insomnia (Standard) and secondary insomnia (Guideline). Stimulus control therapy, relaxation training, and cognitive behavior therapy are individually effective therapies in the treatment of chronic insomnia (Standard) and sleep restriction therapy, multicomponent therapy (without cognitive therapy), biofeedback and paradoxical intention are individually effective therapies in the treatment of chronic insomnia (Guideline). There was insufficient evidence to recommend sleep hygiene education, imagery training and cognitive therapy as single therapies or when added to other specific approaches. Psychological and behavioral interventions are effective in the treatment of insomnia in older adults and in the treatment of insomnia among chronic hypnotic users (Standard).     

Mindfulness-based touch therapy and mindfulness practice in persons with moderate depression

The goal of the study was to explore the effects of mindfulness-based touch therapy, a passive body-therapy intervention, in combination with the practice of mindfulness as an active meditative discipline, in patients with moderate recurring or episodic depression. The method under study is seen as a possible adjunct to psychotherapy and psychopharmacotherapy. The degree of depression before and after the therapy phase was determined according to Hamilton's scale. The outcome was a highly significant improvement in depressive illness, with a general alleviation of depressed mood, reduction in feelings of guilt, in suicidal thoughts and in sleep maintenance insomnia; increase in motivation in carrying out everyday activities; reduction in feelings of anxiety at both psychological and somatic levels and easing of general somatic symptoms. The results show that the method under study can serve persons suffering from depression as an adjunct to conventional therapeutic measures.     

Mourning through Poetry: Discovering the Lost Love Object and Symbolization of Desire

Deborah was referred to me for psychoanalytic psychotherapy following a suicide attempt and depression. We began a fascinating journey spanning more than 10 years. During therapy, many questions arose concerning the suicidal episode, which she could not register consciously. I tried to understand the reasons for her depression and the attempted suicide through the unconscious process in the therapeutic relationship and through the music and poetry that she brought to sessions. In this paper I describe the process of listening for the signifiers of semiotic and symbolic language, both metaphoric and metonymic, as revealed in poetry and music according to the theories of Kristeva and Lacan. The poetry enabled the patient to retrieve childhood memories, experience the movement from unconscious to conscious, and mourn through the experience of transference and countertransference in the therapeutic relationship. Also illustrated is the transition from singing the music to more symbolic language, turning the patient's sensory experience into language, and connecting her personal experience with the culture of her past. The patient's mourning and the lost love objects are discussed through the prism of classical and object relations theories.