A Danish centre contributed 12 cases to a Nordic multicentre investigation concerning the psychotherapy of psychoses. Patients admitted consecutively to the psychiatric hospital with the diagnoses of schizophrenia, schizophreniform psychosis or schizoaffective psychosis were offered psychotherapy at least once weekly for two years in addition to the other treatment modalities administered. In the Danish design, the process of supervision in relation to the processes of psychotherapy was investigated. In the present article, examples are presented illustrating how core psychotic mechanisms in the patients are reflected not only in process-facilitating but also in process inhibiting psychotherapeutic interventions. The data of the investigation are these interventions which are written down prospectively in the summaries of the supervision.
The purpose of this study was to determine whether participation in a group psychosocial intervention by patients with breast cancer would result in an improvement in psychological measures and in reduced billings in general medical expenses.
Eligible women who had completed treatment for stage 0, I, or II primary breast cancer were prospectively and randomly assigned to either the intervention (n=46) or control (n=43) group. Both groups received the usual psychosocial care; however, the intervention group also participated in six weekly cognitive/behavioral psychosocial meetings. All were assessed on psychiatric symptoms, mood, depression, and coping strategies at four time periods: pre-intervention, post-intervention, 1-year follow-up, and 2-year follow-up. Alberta Healthcare billing records were obtained covering the 2-year follow-up period to determine the amount billed per person over the course of the study.
Women in the intervention group had less depression, less overall mood disturbance, better overall quality of life, and fewer psychiatric symptoms than those in the control group, beginning immediately post-intervention and remaining so at 2 years post-intervention. Billing in the intervention group was an average of $147 less than in the control group, a 23.5% reduction.
This is the first study to show that a psychosocial intervention can reduce direct healthcare billings in a sample of patients with cancer. Importantly, these findings help to justify the routine availability of such programs in cancer treatment facilities worldwide.
Comment In: Cancer Pract. 2001 Jan-Feb;9(1):511879266
This prospective, naturalistic study evaluated the practice and effectiveness of an outpatient group therapy program following day treatment for patients with personality disorders (PDs). One hundred and eighty-seven patients (86% patients with PDs and 14% with no PDs), were treated in outpatient psychodynamic group therapy. Outcome was assessed by Global Assessment of Functioning, Symptom Check List 90-R, and Inventory of Interpersonal Problems-Circumplex, short version, at admission and discharge from day treatment, and at the end of outpatient group therapy. Average length of outpatient therapy was 24 months. Forty-three percent terminated in an irregular manner. Outcome of the continuation therapy was satisfactory for patients without PDs. For PD patients, the improvement from the day treatment was maintained during outpatient therapy, but further improvements were modest for symptoms and interpersonal distress, somewhat better for global functioning. Implications for further treatment development are discussed.
A specialized psychotherapeutic day treatment programme was established in a Danish clinical setting on the basis of recent research and advances in treatment for severe personality disorders. This study analyses treatment effectiveness by comparing the day treatment programme with a treatment as usual (TAU) situation as given to personality-disordered patients on a waiting list. The sample consisted of 66 personality-disordered patients consecutively referred and diagnosed according to standardized criteria. The intervention group comprised 38 patients. There was no selection made for the intervention group: when the programme capacity was reached, a waiting list of 28 consecutive patients formed the comparison group; none of these patients figured in the intervention group. Intervention included psychodynamic and cognitive-based therapy in a group/individual setting and lasted 5 months. Outcome measures were self-rated and observer-rated multidimensional evaluation of functioning relevant to personality-disordered patients. The day treatment programme did significantly better in reducing acute and prolonged hospitalizations and suicide attempts, in stabilizing the psychosocial functioning and in reducing complaints that lead to treatment. The intensive day treatment programme stabilized patient functioning but did not lead to changes on personality traits for which more extended treatment might be necessary.
Patients with breast cancer experience unmet informational and psychosocial needs at the end of treatment. A brief psychoeducational intervention delivered at this transition may help to address some of the challenges these women face. The purpose of this study was to test the effectiveness of a single-session group psychoeducational intervention (GBOT group) compared with standard print material (usual care).
In this randomized controlled trial, 442 patients with breast cancer who were completing their adjuvant radiotherapy were recruited and randomized to receive either usual care, which includes standard print material (CRL group n = 226) or usual care and the GBOT group intervention (INT group n = 216). Participants completed measures at baseline and again at 3 and 6 months post-intervention.
The INT group showed significant improvement in their knowledge regarding the re-entry transition period (d = 0.31) and in their feelings of preparedness for re-entry (d = 0.37). There were no differences between the groups over time on health-related distress or mood.
Results support the effectiveness of providing a single-session group psychoeducational intervention as a first-step approach to supportive care for women at the end of breast cancer treatment.
The results of a psychotherapeutic inpatient treatment for alcoholism using the goal of increased control of drinking are reported. The patients participating and the outcome of the first 18 months after treatment are presented. Eighty-six patients participated in the treatment and between 78 and 71 of these could be followed-up. Before the treatment the great majority of the patients drank in accordance with the diagnosis addictive alcoholism. The mean duration of alcohol problems was nine years and the first therapeutic contact had taken place six years ago. The results are compared with the situation on admission and the 12 month period before treatment. After treatment, the mean daily alcohol consumption was nearly halved. About 3/4 of the patients reduced their drinking, half of the patients by more than 50% and 1/4 by more than 75%. Half of the patients drank less than six drinks per day, 1/3 less than four, and 1/4 less than three. The consumption showed a decreasing tendency during the 18 month period mainly due to an increase in non-drinking days. The patients' satisfaction with their mental condition, their relation to family and friends and life in general was greatly increased. The socio-economical problems were restored compared to the situation on commencing treatment but not to a level above the situation in the 12 months period before treatment. It is concluded that severely dependent alcohol abusers can be helped by psychotherapy with their mental or life problems and thereby increase control with their alcohol consumption.
To evaluate the effect of a standardized group psychosocial intervention on health-related quality of life (HrQOL) in women with metastatic breast cancer and to explore the effect of missing data in HrQOL analyses.
Between 1993 and 1998, seven Canadian centers randomly assigned 235 eligible women to participate in a weekly, 90-minute, therapist-led support group that adhered to principles of supportive-expressive (SE) therapy or to a control arm (no SE). All women received educational material and any type of medical or psychosocial care deemed necessary. HrQOL data were prospectively collected using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30 (EORTC QLQ-C30) at baseline, 4, 8, and 12 months. The primary HrQOL analyses compared scores in the two study arms. Analyses were limited to women with appropriate baseline HrQOL information (n = 215).
Baseline EORTC QLQ-C30 scores were not different between the two study arms (all P >.05). Primary analysis of all subscales failed to show a significant influence of the intervention on HrQOL (all P >.05). There was a significant deterioration over time in several functional scales of the EORTC QLQ-C30: global (P =.03), physical (P =.0002), role (P =.01), and cognitive functioning (P =.04); and in symptom scales: dyspnea (P =.007), appetite loss (P =.04), and fatigue (P =.003); these changes were independent of randomization allocation. Results were similar in additional analyses of overall HrQOL using a variety of approaches to handling missing data.
Supportive-expressive group therapy in patients with metastatic breast cancer does not appear to influence HrQOL, as measured by the EORTC QLQ-C30.
In this review of the literature on studies concerning the prevention of suicide and the effect of after-care of patients who have attempted to take their lives it is concluded that no treatment which works has yet been discovered. Of five clinically controlled studies only one suggested that it affected the repetition frequency of attempts at suicide. When other effects were assessed there was an improvement in the patients' social functions and a reduction in their abuse of alcohol. The studies have shown that not only psychiatrists but also other physicians and categories of personnel can undertake attendance on, and after-care of patients who have attempted suicide provided that they receive the necessary training and supervision.
The investigations of authors concerning infants and their families were generalized on the basis of the observations of infants and their parents with some psychological problems in families. The principles of psychotherapeutic work in above-mentioned groups were formulated. Besides the methods of the diagnosis of psychical deviations development in first year infants as well as peculiarities of alterations in mother-baby system and the main forms of psychic disturbances correction in infants were also described.