Measuring Outcome in Psychogenic Nonepileptic Seizures: How Relevant Is Seizure Remission?

PURPOSE: To examine whether seizure remission is a comprehensive marker of outcome in psychogenic nonepileptic seizures (PNESs). METHODS: A postal questionnaire was returned by 147 patients with PNESs a mean of 4.2 years after diagnosis (mean age at follow-up, 38.1 years). The proportion of patients who were "unproductive" (receiving health-related state benefits) at follow-up was determined, with a comparison of markers of ongoing psychopathology (Global Severity Index, anxiety and depression scores of the Symptom Checklist 90, Somatization Index DSM of the SOMS-2) in three outcome groups: group 1, continuing seizures; group 2, seizures stopped but patients "unproductive;" and group 3, seizures stopped, patients "productive." RESULTS: Of the patients, 71.4% continued to have seizures, and 28.6% had achieved seizure remission; 60.0% of patients with continuing seizures and 42.7% of patients in remission were "unproductive" (difference, NS). Ongoing psychopathology was related to the factor "group membership" with higher values in groups 2 and 3 than in group 1 (GSI, p < 0.001; anxiety, p = 0.01; depression, p = 0.02; Somatization Index DSM, p < 0.001). Across all patients and in the subgroup with PNESs and additional epilepsy, differences were significant only between groups 2 and 3, not between groups 1 and 2. In patients with PNESs alone, differences were significant only between groups 1 and 2. CONCLUSIONS: Seizure remission is not a comprehensive measure of good medical or psychosocial outcome in PNESs. Nearly half the patients who become seizure free remain unproductive. Many of these patients continue to report symptoms of psychopathology. Seizure control should not be the only focus of treatment in clinical practice or outcome observation in research studies.     

Interpersonal psychotherapy adapted for the group setting in the treatment of postpartum depression

Interpersonal psychotherapy (IPT) has demonstrated efficacy in the individual treatment of antepartum and postpartum depression. The current investigation extends prior work by examining the efficacy of a group IPT approach for the treatment of postpartum depression. Depression scores of 17 women diagnosed with postpartum depressive disorder (DSM-IV criteria) decreased significantly from pre- to post-treatment. Follow-up assessments at 6 months revealed continuation of the treatment effect. Results indicate that IPT adapted for a group model has positive implications for the treatment of postpartum depression, demonstrating both short-term and longer-term effects in the reduction of depressive symptomatology. Study limitations include the small sample size, absence of control group, possible bias in therapist's assessments, and lack of monitoring adherence, which may have jeopardized the accuracy of the results.     

Time-limited psychotherapy with adolescents

Short-term dynamic therapies, characterized by abbreviated lengths (10-40 sessions) and, in many cases, preset termination dates, have become more widespread in the past three decades. Short-term therapies are based on rapid psychodynamic diagnosis, a therapeutic focus, a rapidly formed therapeutic alliance, awareness of termination and separation processes, and the directive stance of the therapist. The emotional storm of adolescence, stemming from both developmental and psychopathological sources, leaves many adolescents in need of psychotherapy. Many adolescents in need of therapy resist long-term attachment and involvement in an ambiguous relationship, which they experience as a threat to their emerging sense of independence and separateness. Short-term dynamic therapy can be the treatment of choice for many adolescents because it minimizes these threats and is more responsive to their developmental needs. The article presents treatment and follow-up of a 17-year-old youth, using James Mann's time-limited psychotherapy method.     

Adverse outcomes in group psychotherapy: risk factors, prevention, and research directions

Group forms of therapy have been growing at a rapid rate, in part because of their documented effectiveness and economic considerations such as managed care. It is therefore becoming increasingly important to assess the psychological risks of these interventions. The author provides an overview of the published literature and conference presentations on negative effects in adult outpatient groups. Although much of the literature on adverse outcomes in group therapy focuses on single risk factors (e.g., negative leader, group process, or patient characteristics), the author argues that an interactional model should be encouraged. Means of reducing casualties are also discussed, as well as methodological issues and research directions.     

Inadequacy and indebtedness: no-fee psychotherapy in county training programs

The nature of the fee arrangement has significant influence on the psychotherapeutic process even when there is no fee. Given the large number of psychiatrists who receive at least some part of their training in the public system, understanding the no-fee arrangement is vital to the psychodynamic training of future psychiatrists. Following a brief overview of the meaning of money and the fee arrangement, various scenarios are considered under the headings of "inadequacy" and "indebtedness. "Although similar dynamics may be present in other public and private settings, attention is given to the county training program, with the intent to assist psychiatry residents and supervisors in their awareness and understanding of the psychodynamics of psychotherapy without fee.     

Role behavior expectancies and alliance change in short-term individual psychotherapy

Patients and therapists participating in a clinical trial of short-term, time-limited individual (STI) psychotherapy were asked to rate expectancies regarding their own and their counterpart's role behaviors during sessions. Significant relationships differed according to the index of alliance used (patient, therapist) and as a function of scores on a global patient personality measure known as Quality of Object Relations (QOR). Among high-QOR (or mature) cases, the patient's expectancy of being able to contribute to the treatment process was inversely associated with change in the patient-rated alliance. For those with low QOR (more primitive object relations), congruence of expectancies regarding a supportive therapist role was directly associated with change in the therapist-rated alliance. Results are discussed in terms of evaluating and preparing patients for psychotherapy and the appropriate therapeutic strategies for patients of different QOR.     

幻肢痛

幻肢现象不仅局限于四肢,身体其他部位被切除时也会发生,其中幻肢痛的发生率约占60%～70%。最近,其发病机制中大脑皮层功能重组和幻肢感、幻肢痛的相关性受到重视,认为很可能是幻肢痛产生的中枢性机制之一。幻肢痛的治疗极为困难,治疗方式多种多样,被证明行之有效的包括药物治疗、神经阻滞治疗、外科治疗、心理疗法等。治疗方案仍然没有统一和定论。     

药物治疗与心理康复疗法治疗脑卒中临床观察

目的：通过随机分组，临床对照研究，对脑卒中患者的心理康复与药物的综合治疗效果进行客观评价。方法：将80例脑卒中患者随机分为研究组和对照组。对照组给予常规药物治疗并配合一个疗程的针灸理疗，研究组则在常规药物治疗及相同疗程理疗之外给予有步骤的心理康复治疗。以6周为评定疗效的时间界限。结果：研究组总有效率为95．0％，显效率为57．5％，对照组总有效率为92．5％，显效率为30．0％，显效率相比较具有统计学意义（P〈0．05）。结论：心理康复治疗与药物综合治疗脑卒中疗效显著，与传统针灸理疗加药物治疗脑卒中在显效率上差异有显著性。     

Ericksonian hypnosis in tinnitus therapy: effects of a 28-day inpatient multimodal treatment concept measured by Tinnitus-Questionnaire and Health Survey SF-36

For the first time, the therapeutic effects on subacute and chronic tinnitus of an inpatient multimodal treatment concept based on principles of Ericksonian hypnosis (EH) were examined by standardized criteria of the Tinnitus Questionnaire (TQ) and Health Survey (SF-36) within a controlled prospective, longitudinal study. A total of 393 patients were treated within an inpatient closed-group 28-day-setting based on a resource-oriented, hypnotherapeutic concept. The severity of tinnitus was assessed by TQ at times of admission, discharge and also at a 6- and 12-month follow-up. Health-related quality of life was evaluated before and after therapy using the SF-36. After therapy, a decrease in TQ score was seen in 90.5% of the patients with subacute tinnitus and in 88,3% of those with chronic tinnitus. Assessment of the TQ score at the end of therapy revealed highly significant improvements of 15.9/14.1 points in mean. Effect sizes in the treatment groups (0.94/0.80) were superior to those in the waiting-list controls (0.14/0.23). The TQ score remained stable in the follow-up controls. Significant improvement in health-related quality of life has been observed within the treatment groups depending on initial level of tinnitus serverity I–IV according to TQ. Using a multimodal treatment concept with emphasis on resource-activating approaches of EH the annoyance of tinnitus can be significantly reduced while health-related quality of life is enhanced within a comparatively short treatment period of 28 days.