Psychotherapy in a Day Clinic: Results of a 1.5 Year Follow-Up

Objective: In a prospective, naturalistic 1.5 year follow-up study of N = 114 consecutively admitted day clinic patients efficacy of the program and predictors of outcome are evaluated. Methods: Patients had severe neurotic disturbances and personality disorders. Interviews and questionnaires (SCL-90-R, EDI) were used for evaluation at admission, discharge and follow-up. Results: From 79.8% of the patients information could be obtained. In the main diagnostic categories between 30 to 50% of the patients showed complete remissions at follow-up. Patients at least kept improvements at follow-up. The rating of the transition phase after discharge was predictive for outcome. The group of patients that rated this phase as difficult showed higher levels of psychopathology at admission. Conclusions: It is possible to treat severely disturbed patients in a psychotherapeutic day clinic with good and lasting effects. A more disturbed group of patients needs special help to cope with the transition into the outpatient situation.     

A Follow-up Study of Characteristics of Young People that Dropout and Continue Psychotherapy: Service Implications for a Clinic in the Community

Background:  The paper reports the findings from a follow-up study of the factors that contribute to whether young people dropout or continue once-weekly psychotherapy at a voluntary sector psychotherapy service for young people aged 12 to 21 years.
Method:  The study uses data from an ongoing audit of the psychotherapy service that started in 1993; 882 young people were included in the study. Premature termination of treatment was defined as dropping out before the 21^st session. Continuation in treatment was defined as remaining in therapy after 20 sessions. Measures and areas of interest used in the study include diagnostic measures, the Youth Self Report Form and Young Adult Self Report Form, demographic characteristics and treatment related information.
Results:  Young people who continued in treatment were more likely to be older, have anxieties about sexual and relationship issues and have higher scores on self-reported anxiety-depression. Young people who dropped out of treatment were more likely to be younger, have higher self-reported delinquency scores, have a diagnosis of hyperactivity-conduct disorder and be homeless.
Conclusions:  The study of treatment termination has demonstrated the value of service audit and has led to a significant change in clinical practice.     

Evidence-Based Psychotherapy for Children and Adolescents: Data from the Present and a Model for the Future

What is the best way to help children cope with behavioural and emotional problems? This question has been a focus of concern — to children and the adults who care for them — across many centuries and in cultures around the world. In this article we examine the current state of efforts to help children by means of an array of non‐medical interventions designed to alleviate psychological distress, reduce maladaptive behaviour, and/or increase adaptive behaviour. We refer to these interventions, collectively, as ‘psychotherapy’. In the article, we will note some accomplishments of the effort to develop effective interventions through clinical research. Then we will note some concerns about these efforts, and suggest ways to address the concerns through an alternate model of intervention development and testing.     

Structured Disposition Planning for Adolescent Suicide Attempters in a General Hospital: Preliminary Findings on Short-Term Outcome

Adolescent suicide attempters are often noncompliant with outpatient psychotherapy and drop out of treatment much more quickly than non-suicidaladolescents. In this study, 23 adolescents received medical treatment and astandard psychiatric evaluation in an Emergency Department following asuicide attempt. In addition, all subjects and their parents received apsychotherapy compliance enhancement intervention which included a verbalagreement between the adolescent and parent/guardian to attend at least fourpsychotherapy sessions. After discharge from the hospital, each subjectreceived three phone interviews over an 8 week period using a problemsolving approach around two key areas: suicidal ideation and psychotherapycompliance. Compared to a three month follow-up of 78 subjects (which didnot include an experimental intervention), conducted at the same hospital,the experimental intervention resulted in fewer outpatient psychotherapy noshows (9% vs. 18%) and a trend toward greater number ofsessions attended (5.5 vs. 3.9). There were no re-attempts in theexperimental group as compared to 9% in the comparison group. Resultsare promising and a randomized intervention trial appears indicated.     

Outcome of mentalization‐based and supportive psychotherapy in patients with borderline personality disorder: a randomized trial

Objective: This study presents data from a randomized outcome study comparing mentalization‐based and supportive psychotherapy for patients with borderline personality disorder (BPD). Method: Eighty‐five SCID‐II diagnosed borderline patients were randomized to either i) 2 years of intensive (twice weekly) combined (individual and group), mentalization‐based psychotherapy (MBT) or ii) 2 years of less‐intensive (biweekly) supportive group therapy. Treatment outcome was assessed using a battery of self‐report questionnaires, SCID‐II interviews and therapist‐rated global assessment of functioning (GAF). Results: Fifty‐eight patients completed 2 years of treatment. Significant changes in both treatment groups were identified for several outcome measures, including self‐reported measures of general functioning, depression, social functioning and number of diagnostic criteria met for BPD, as outlined by the SCID‐II interview. General linear modelling was used to compare treatment outcome in the two groups. Only GAF showed a significantly higher outcome in the MBT group. A trend was found for a higher rate of recovery from BPD in the MBT group. Pre‐post effect sizes were high (0.5–2.1) and for the most part highly significant in both groups. Conclusion: The study indicates that both MBT and supportive treatment are highly effective in treating BPD when conducted by a well‐trained and experienced psychodynamic staff in a well‐organized clinic.     

Pitfalls in the Assessment,Analysis, and Interpretation of Routine Outcome Monitoring (ROM) Data: Results from an Outpatient Clinic for Integrative Mental Health

There is considerable debate about routine outcome monitoring (ROM) for scientific or benchmarking purposes. We discuss pitfalls associated with the assessment, analysis, and interpretation of ROM data, using data of 376 patients. 206 patients (55 %) completed one or more follow-up measurements. Mixed-model analysis showed significant improvement in symptomatology, quality of life, and autonomy, and differential improvement for different subgroups. Effect sizes were small to large, depending on the outcome measure and subgroup. Subtle variations in analytic strategies influenced effect sizes substantially. We illustrate how problems inherent to design and analysis of ROM data prevent drawing conclusions about (comparative) treatment effectiveness.     

Interpersonal Psychotherapy for Depressed Adolescents (IPT‐ A): Extending the Reach from Academic to Community Settings1

Depression is a persistent and impairing illness for adolescents. Many adolescents have limited access to care and/or do not receive adequate treatment for their depression. Researchers have developed a number of empirically supported interventions for adolescent depression; the challenge is to bring these treatments into community settings and assess their effectiveness under real world conditions. This paper provides a critical examination of research conducted on the use of Interpersonal Psychotherapy for depressed adolescents (IPT‐A). The paper presents evidence for the efficacy and effectiveness of IPT‐A. Implementation and dissemination efforts are discussed in regard to lessons learned and directions for future research.     

Developmental origins of depression‐related white matter properties: Findings from a prenatal birth cohort

Depression is the leading cause of years lost due to disability worldwide. Still, the mechanisms underlying its development are not well understood. This study aimed to evaluate white‐matter properties associated with depressive symptomatology in young adulthood and their developmental origins. Diffusion tensor imaging and assessment of depressive symptomatology were conducted in 128 young adults (47% male, age 23–24) from a prenatal birth cohort (European Longitudinal Study of Pregnancy and Childhood). For a subset of these individuals, the database included information on prenatal stress (n = 93) and depressive symptoms during adolescence (assessed repeatedly at age 15 and 19). Depressive symptoms in young adulthood were associated with lower fractional anisotropy in the left and right cingulum and higher fractional anisotropy in the right corticospinal tract and superior longitudinal fasciculus. Further analyses revealed that prenatal stress and depressive symptomatology during adolescence were independent predictors of altered white‐matter properties in the cingulum in young adulthood. We conclude that typically developing young adults with more depressive symptoms already exhibit tract‐specific alterations in white‐matter properties and that prenatal stress and depressive symptomatology during adolescence might contribute to their development.     

Mania,Hypomania, and Suicidality: Findings from a Prospective Community Study

ABSTRACT

We examined prospectively whether mania and hypomania are associated with an elevated risk for suicidality in a community sample of adolescents and young adults. Baseline and four-year follow-up data were used from the Early-Developmental-Stages-of-Psychopathology (EDSP) Study, a prospective longitudinal study of adolescents and young adults in Munich. Suicidal tendencies (ideation/attempts), mania, and hypomania were assessed using the standardized Munich-Composite-International-Diagnostic-Interview. At baseline, mania/hypomania was associated to a different degree with suicidality (Odds ratios [OR] range from 1.9 to 13.7). In the prospective analyses, the risk for subsequent incident suicidal ideation was increased in the presence of prior mania (38.0% vs. 14.1%; OR = 4.4; 95% CI = 1.4–13.5). No associations could be found between prior mania/hypo-mania and incident suicide attempts. The prospective analyses revealed a remarkable relationship between preexisting mania and increased risk for subsequent suicidal ideation.     

Outcome of Psychogeriatric Intervention in an Old-Age Home: A 3 Years Follow-up Study

Psychogeriatrics and especially psychiatric services in nursing and old-age homes are sorely lacking in research. Four years ago we developed and implemented a model for service delivery for old-age homes within our hospitals' catchment area. In the first year of operation 48 of 373 residents (13%) were evaluated and treated by a psychogeriatrician. The aim of the present study was to evaluate outcome of these patients three years later. All patients and medical records were re-assessed. During the three-year period 16/48 subjects (33.3%) passed away; of these half were previously diagnosed as suffering from a major depressive episode. None of the subjects who died had attempted suicide. Following a preliminary diagnosis of affective spectrum disorder, 4/48 patients (8.3%) were re-diagnosed at follow up as suffering from dementia. Full or partial remission of the original symptomatology was achieved in 18/32 surviving subjects (50.7%); mostly depressed or anxious patients. We conclude that although mortality rate among elderly psychiatric patients is high persistent interventions lead to successful remission in the majority of patients.     

Mentalization as a moderator of treatment effects: Findings from a randomized clinical trial for personality disorders

Abstract

Mentalization is the capacity to understand behavior as expressions of various mental states. It is assumed to be important for understanding the underlying psychopathology, the therapeutic process, and the outcome of therapy associated with patients with personality disorders (PDs). However, to date, empirical findings are scarce and inconsistent. This study aimed to examine whether the pre-treatment level of mentalization, operationalized as Reflective Functioning (RF), was associated with differential responses to two different treatment modalities and might predict clinical improvement. We analyzed data from a randomized clinical trial (Ullevål Personality Project). Seventy-eight patients with borderline and/or avoidant PD had been randomly assigned to either a step-down treatment program or outpatient individual psychotherapy. The step-down treatment comprised short-term day hospital treatment, followed by long-term, combined group and individual psychotherapy. RF was rated before treatment and after 36 months. Outcome measures were administered at baseline and after 8, 18, and 36 months. The moderator analyses indicated that patients with low RF levels at baseline responded better to outpatient individual psychotherapy than to the step-down treatment in terms of improvements in psychosocial functioning. Patients with medium-high RF levels responded equally well to both therapy formats. Determining which therapy format is appropriate for specific groups of patients can improve treatment efficiency. Therefore, our findings may have important clinical implications. Future research should address RF as a mediator of change.     

Gender-Specific Incidence and Predictors of Cognitive Impairment among Older Koreans: Findings from a 6-Year Prospective Cohort Study

ObjectiveThis study investigated gender-specific incidence and predictors of cognitive impairment among community-dwelling older adults in South Korea.MethodsUsing data from the 2006 and 2012 Korean Longitudinal Study of Ageing (KLoSA), 925 females and 834 males aged 65 and over without cognitive impairment at 2006 were analyzed separately. Cognitive impairment was measured based on the Korean version of the Mini-Mental State Exam (K-MMSE) normative score. Generalized Estimating Equations (GEE) was conducted to examine the predictors of cognitive impairment at 6-year follow up.ResultsIncidence of cognitive impairment at 2012 was significantly higher for women (30.5%) than men (26.1%). GEE result showed that depression was significantly associated with cognitive impairment for both genders (female: OR=2.26, 95% CI=1.63–3.12; male: OR=3.26, 95% CI=2.19–4.83). Having IADL limitations (OR=1.15, 95% CI=1.03–1.28), high blood pressure (OR=1.72, 95% CI=1.27–2.34), poor hearing (OR=1.94, 95% CI=1.29–2.92), regular exercise (OR=0.67, 95% CI=0.45–0.99), and normal weight (OR=1.39, 95% CI=1.03–1.86) were significant predictors of cognitive impairment only among women. In contrast, age (OR=1.04, 95% CI=1.01–1.07) and ADL limitations (OR=1.48, 95% CI=1.21–1.82) were significant predictors of cognitive impairment at follow-up only among men.ConclusionFindings of this study show gender-specific predictors of cognitive impairment among older Koreans. This study can provide information for clinicians and policy makers to develop different intervention strategies considering gender differences in the progress of cognitive impairment.