Has number of previous episodes any effect on response to group psychoeducation in bipolar patients? A 5-year follow-up post hoc analysis

2010 ◽  
Vol 22 (2) ◽  
pp. 50-53 ◽  
Author(s):  
Francesc Colom ◽  
María Reinares ◽  
Isabella Pacchiarotti ◽  
Dina Popovic ◽  
Lorenzo Mazzarini ◽  
...  
Keyword(s):  
Treatment Strategies ◽  
Bipolar Disorders ◽  
Study Entry ◽  
Mixed States ◽  
Psychological Therapies ◽  
Time To Recurrence ◽  
Group Psychoeducation ◽  
Bipolar Patients ◽  
Post Hoc

Colom F, Reinares M, Pacchiarotti I, Popovic D, Mazzarini L, Martínez-Arán A, Torrent C, Rosa A, Palomino-Otiniano R, Franco C, Bonnin CM, Vieta E. Has number of previous episodes any effect on response to group psychoeducation in bipolar patients? A 5-year follow-up post hoc analysis.Objective:One of the main utilities of staging in bipolar disorder is enhancing the formulation of pharmacological and non-pharmacological treatment strategies. Hence, it is essential to ascertain whether the number of previous episodes influences treatment response. Hereby, we present a 5-year post hoc study on the efficacy of group psychoeducation for bipolar disorders according to the number of previous episodes.Methods:For this subanalysis, we have compared the 5-year outcome of 120 euthymic psychoeducated versus non-psychoeducated bipolar patients according to the number of previous episodes at study entry.Results:Patients with more than seven episodes at study entry did not show any significant improvement with psychoeducation according to time to recurrence. Patients with more than 14 episodes did not benefit from psychoeducation in terms of a reduction of time spent ill. Patients with 7 or 8 episodes showed a benefit in terms of fewer days spent in hypomania, depression, mixed episodes or any episodes but not mania, while patients with 9–14 episodes showed a benefit in terms of fewer days spent in hypomania and depression but not in mixed states or mania. Only patients who presented up to 6 episodes showed reduction in time spent in any episode polarity.Conclusion:The number of previous episodes clearly worsens response to psychoeducation, perhaps in a more subtle way than that observed with other psychological therapies. Psychoeducation should be delivered as soon as possible in the illness course, supporting the idea of early intervention.

scholarly journals Cognitive–behavioural therapy for severe and recurrent bipolar disorders

2006 ◽  
Vol 188 (4) ◽  
pp. 313-320 ◽  
Author(s):  
Jan Scott ◽  
Eugene Paykel ◽  
Richard Morriss ◽  
Richard Bentall ◽  
Peter Kinderman ◽  
...  
Keyword(s):  
Cognitive Behavioural Therapy ◽  
Mental Healthcare ◽  
Bipolar Disorders ◽  
Behavioural Therapy ◽  
Recurrence Rates ◽  
Treatment As Usual ◽  
Psychological Therapies ◽  
Cognitive Behavioural ◽  
Randomised Controlled ◽  
Post Hoc

BackgroundEfficacy trials suggest that structured psychological therapies may significantly reduce recurrence rates of major mood episodes in individuals with bipolar disorders.AimsTo compare the effectiveness of treatment as usual with an additional 22 sessions of cognitive–behavioural therapy (CBT).MethodWe undertook a multicentre, pragmatic, randomised controlled treatment trial (n=253). Patients were assessed every 8 weeks for 18 months.ResultsMore than half of the patients had a recurrence by 18 months, with no significant differences between groups (hazard ratio=1.05; 95% CI 0.74–1.50). Post hoc analysis demonstrated a significant interaction (P=0.04) such that adjunctive CBT was significantly more effective than treatment as usual in those with fewer than 12 previous episodes, but less effective in those with more episodes.ConclusionsPeople with bipolar disorder and comparatively fewer previous mood episodes may benefit from CBT. However, such cases form the minority of those receiving mental healthcare.

scholarly journals Group psychoeducation for stabilised bipolar disorders: 5-year outcome of a randomised clinical trial

2009 ◽  
Vol 194 (3) ◽  
pp. 260-265 ◽  
Author(s):  
F. Colom ◽  
E. Vieta ◽  
J. Sánchez-Moreno ◽  
R. Palomino-Otiniano ◽  
M. Reinares ◽  
...  
Keyword(s):  
Group Intervention ◽  
Psychological Intervention ◽  
Controlled Trial ◽  
Bipolar Disorders ◽  
Randomised Clinical Trial ◽  
Median Number ◽  
Group Psychoeducation ◽  
Randomised Controlled

BackgroundThe long-term efficacy of psychological interventions for bipolar disorders has not been tested.AimsThis study assessed the efficacy of group psychoeducation to prevent recurrences and to reduce time spent ill for people with bipolar disorders.MethodA randomised controlled trial with masked outcome assessment comparing group psychoeducation and non-structured group intervention during 5-year follow-up. One hundred and twenty people with bipolar disorders were included in the study and 99 completed 5-year follow-up. Time to any recurrence, number of recurrences, total number of days spent ill, frequency and length of hospitalisations were the main outcome measures.ResultsAt the 5-year follow-up, time to any recurrence was longer for the psychoeducation group (log rank=9.953, P<0.002). The psychoeducation group had fewer recurrences (3.86 v. 8.37, F=23.6, P<0.0001) of any type and they spent less time acutely ill (154 v. 586 days, F=31.66, P=0.0001). The median number of days of hospitalisation per hospitalised participant was also lower for the psychoeducation group (45 v. 30, F=4.26, P=0.047).ConclusionsSix-month group psychoeducation has long-lasting prophylactic effects in individuals with bipolar disorders. Group psychoeducation is the first psychological intervention showing such a long-term maintained efficacy in people with bipolar disorders.

scholarly journals Prognostic factors associated with survival and recurrence in resectable gastroesophageal adenocarcinoma: retrospective analysis of 497 patients operated at two Italian centers.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e15588-e15588
Author(s):  
Michele Ghidini ◽  
Andrea Botticelli ◽  
Bianca Maria Donida ◽  
Lidia Strigari ◽  
Concetta Elisa Onesti ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Univariate Analysis ◽  
Treatment Strategies ◽  
High Volume ◽  
Tumor Location ◽  
Large Cohort ◽  
Curative Intent ◽  
Time To Recurrence ◽  
Gastroesophageal Adenocarcinoma

e15588 Background: Chemotherapy (CT) and chemoradiotherapy (CTRT) both in neoadjuvant (neoadj) or adjuvant (adj) setting are associated with better overall survival (OS) over surgery alone in patients (pts) with resectable gastroesophageal (GE) adenocarcinoma (ADK). The best sequence and timing of treatments have still not been defined. A large cohort of GE ADKs derived from 2 high-volume Italian centers was analyzed to describe clinical outcomes and prognostic factors. Methods: 497 patients (pts) diagnosed with GE ADK who underwent surgery with curative intent from 2007 to 2016 were considered. Variables analyzed were: age, sex, tumor location, histology, T, N, M, R, G, HER-2, Helicobacter Pylori (HP) infection, (neo)adj CT, and adj CTRT. Analysis was performed according to ITT principle. Results: Median age at diagnosis was 71 years (range 35-92). At 26.7 months (mo) median follow-up, median OS was 27.6 mo (range 1-127) and median time to recurrence (TTR) 10.8 mo (range 7.8-13.1). Adj CT was administered in 203 cases (41%); 116 pts (23%) had adj CTRT and 47 (9%) neoadj CT. Statistically significant variables for OS and/or TTR at 12 months at univariate analysis were: age, T, N, M, R, G, adj CTRT, neoadj CT and adj CT. Results of multivariate analysis (MVA) are shown in Table 1. Conclusions: Despite a short follow-up, our analysis performed on a very large cohort of consecutive pts confirms the prognostic value of T and N for both OS and TTR. Adj CT and CTRT had a significant impact on 1 year OS, while neoadj CT gave only a 12 months TTR significant benefit. Based on these results, perioperative treatment strategies should always be considered in the management of resectable GE cancer. [Table: see text]

Impact of cognitive-psychoeducational interventions in bipolar patients and their relatives

2006 ◽  
Vol 21 (2) ◽  
pp. 81-86 ◽  
Author(s):  
Britta Bernhard ◽  
Annette Schaub ◽  
Petra Kümmler ◽  
Sandra Dittmann ◽  
Emanuel Severus ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Group Intervention ◽  
Bipolar Disorders ◽  
Warning Signs ◽  
Psychoeducational Group ◽  
Before And After ◽  
Expressed Emotions ◽  
Bipolar Patients ◽  
Psychoeducational Interventions

AbstractBackground.In recent years, several controlled studies could show that psychoeducational interventions have been effective for relapse prevention in bipolar disorders. We therefore established a cognitive-psychoeducational group intervention with 14 sessions providing information about the illness, early warning signs, cognitive and behavioural strategies for stress management and social rhythm. Additionally we offered a group intervention for the patients' relatives. The objective of this study was to describe the outcome associated with our psychoeducational intervention in bipolar patients and their relatives.Methods.Sixty-two bipolar patients attended 14 sessions (à 90 min) of cognitive-psychoeducational group therapy. Patients' knowledge of bipolar disorder and their satisfaction with the treatment were assessed using self-developed questionnaires before and after the group intervention. Additionally, 49 relatives of bipolar patients received two psychoeducational workshops of 4 hours each. We assessed demographic variables, burden, high expressed emotion and depressive symptoms of the relatives before and after the two workshops and at 1-year follow-up.Results.Patients significantly improved their knowledge of bipolar disorder. They also have benefited from the discussions and the exchange of useful coping strategies. Burden and high expressed emotions showed no significant reductions at post-assessment, however they were significantly reduced at 1-year follow-up. Relatives also felt significantly better informed about the illness.Conclusions.These findings show that psychoeducational interventions in bipolar patients and their relatives improve patients' and their relatives' knowledge of the illness and the burden of the disorder as well as high expressed emotions are reduced in relatives at 1-year follow-up.

Recurrent Affective Syndromes in Bipolar and Unipolar Mood Disorders at Follow-Up

1995 ◽  
Vol 166 (3) ◽  
pp. 382-385 ◽  
Author(s):  
Joseph F. Goldberg ◽  
Martin Harrow ◽  
Linda S. Grossman
Keyword(s):  
Psychosocial Functioning ◽  
Work Performance ◽  
Bipolar Disorders ◽  
Unipolar Depression ◽  
Work Impairment ◽  
Hospital Work ◽  
Bipolar Patients ◽  
Manic Patients ◽  
Overall Functioning

BackgroundIt is in dispute whether affective relapse disrupts psychosocial functioning to the same extent in depressed and manic patients.MethodA prospective, naturalistic, longitudinal follow-up of 84 unipolar and bipolar affectively disordered in-patients was conducted to examine the extent of recurrent affective syndromes and their relationship to overall outcome. Global adjustment relative to relapse was assessed at 2- and 4.5-year follow-ups.ResultsNearly half of the bipolar patients had subsequent syndromes, which were often associated with uniformly poor psychosocial functioning. Fewer than one-quarter of those with recurrences had steady work performance. Bipolar patients taking lithium alone had fewer recurrences than those taking lithium as well as neuroleptics (P<0.05). Bipolar and unipolar patients relapsed with equal frequency, but unipolar relapse was less often associated with readmission to hospital, work impairment, or uniformly poor functioning.ConclusionAffective relapse in bipolar disorders was more detrimental to overall functioning than was recurrence in unipolar depression.

scholarly journals Risk of Thyroid Disease in Individuals with Celiac Disease

2008 ◽  
Vol 93 (10) ◽  
pp. 3915-3921 ◽  
Author(s):  
Peter Elfström ◽  
Scott M. Montgomery ◽  
Olle Kämpe ◽  
Anders Ekbom ◽  
Jonas F. Ludvigsson
Keyword(s):  
Celiac Disease ◽  
Thyroid Disease ◽  
Cox Regression ◽  
Conditional Logistic Regression ◽  
Reference Population ◽  
Study Entry ◽  
Cross Sectional ◽  
General Population Cohort ◽  
Post Hoc

Background: It has been suggested that celiac disease is associated with thyroid disease. Earlier studies, however, have been predominately cross-sectional and have often lacked controls. There is hence a need for further research. In this study, we estimated the risk of thyroid disease in individuals with celiac disease from a general population cohort. Methods: A total of 14,021 individuals with celiac disease (1964–2003) and a matched reference population of 68,068 individuals were identified through the Swedish national registers. Cox regression estimated the risk of thyroid disease in subjects with celiac disease. Analyses were restricted to individuals with a follow-up of more than 1 yr and with no thyroid disease before study entry or within 1 yr after study entry. Conditional logistic regression estimated the odds ratio for subsequent celiac disease in individuals with thyroid disease. Results: Celiac disease was positively associated with hypothyroidism [hazard ratio (HR) = 4.4; 95% confidence interval (CI) = 3.4–5.6; P &lt; 0.001], thyroiditis (HR = 3.6; 95% CI =1.9–6.7; P &lt; 0.001) and hyperthyroidism (HR = 2.9; 95% CI = 2.0–4.2; P &lt; 0.001). The highest risk estimates were found in children (hypothyroidism, HR = 6.0 and 95% CI = 3.4–10.6; thyroiditis, HR = 4.7 and 95% CI = 2.1–10.5; hyperthyroidism, HR = 4.8 and 95% CI = 2.5–9.4). In post hoc analyses, where the reference population was restricted to inpatients, the adjusted HR was 3.4 for hypothyroidism (95% CI = 2.7–4.4; P &lt; 0.001), 3.3 for thyroiditis (95% CI = 1.5–7.7; P &lt; 0.001), and 3.1 for hyperthyroidism (95% CI = 2.0–4.8; P &lt; 0.001). Conclusion: Celiac disease is associated with thyroid disease, and these associations were seen regardless of temporal sequence. This indicates shared etiology and that these individuals are more susceptible to autoimmune disease.

The Link Between Verbal Short-Term Memory and Anomia Treatment Gains

2019 ◽  
Vol 28 (3) ◽  
pp. 1039-1052
Author(s):  
Reva M. Zimmerman ◽  
JoAnn P. Silkes ◽  
Diane L. Kendall ◽  
Irene Minkina
Keyword(s):  
Short Term Memory ◽  
Controlled Trial ◽  
Treatment Success ◽  
Linear Regression Models ◽  
Language Performance ◽  
Short Term ◽  
Term Memory ◽  
Treatment Gains ◽  
Post Hoc

Purpose A significant relationship between verbal short-term memory (STM) and language performance in people with aphasia has been found across studies. However, very few studies have examined the predictive value of verbal STM in treatment outcomes. This study aims to determine if verbal STM can be used as a predictor of treatment success. Method Retrospective data from 25 people with aphasia in a larger randomized controlled trial of phonomotor treatment were analyzed. Digit and word spans from immediately pretreatment were run in multiple linear regression models to determine whether they predict magnitude of change from pre- to posttreatment and follow-up naming accuracy. Pretreatment, immediately posttreatment, and 3 months posttreatment digit and word span scores were compared to determine if they changed following a novel treatment approach. Results Verbal STM, as measured by digit and word spans, did not predict magnitude of change in naming accuracy from pre- to posttreatment nor from pretreatment to 3 months posttreatment. Furthermore, digit and word spans did not change from pre- to posttreatment or from pretreatment to 3 months posttreatment in the overall analysis. A post hoc analysis revealed that only the less impaired group showed significant changes in word span scores from pretreatment to 3 months posttreatment. Discussion The results suggest that digit and word spans do not predict treatment gains. In a less severe subsample of participants, digit and word span scores can change following phonomotor treatment; however, the overall results suggest that span scores may not change significantly. The implications of these findings are discussed within the broader purview of theoretical and empirical associations between aphasic language and verbal STM processing.

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