Do Therapist Experience, Diagnosis and Functional Level Predict Outcome in Short Term Psychotherapy?

1994 ◽  
Vol 39 (3) ◽  
pp. 168-176 ◽  
Author(s):  
Arthur Propst ◽  
Joel Paris ◽  
Zeev Rosberger
Keyword(s):  
Symptom Severity ◽  
Diagnostic Category ◽  
Severity Index ◽  
Global Assessment Of Functioning ◽  
Brief Psychotherapy ◽  
Global Severity Index ◽  
Functional Level ◽  
Therapist Experience ◽  
Gaf Scores

The purpose of this study was to investigate the effects of clinical diagnosis, functional level and therapist experience on the outcome of brief psychotherapy. Patients (N = 123) were clinically diagnosed and assigned to either a psychiatrist, psychiatry resident, family practice resident or medical student. Global Assessment of Functioning (GAF) scores and the Global Severity Index (GSI) of the SCL-90 were rated at baseline, at the end of therapy and at six month follow-up. The Client Satisfaction Questionnaire was also scored after therapy. All groups of patients improved significantly. Neither therapist type and diagnostic category nor their interaction were related to outcome GAF or to GSI. Patients improved irrespective of their baseline symptom severity. Satisfaction with therapy was highly related to increased functioning and decreased symptom severity. The number of therapy sessions attended by patients was modestly related to outcome and patient satisfaction. The results suggest that many diagnostic groups benefit from brief psychotherapy administered by therapists of varying experience. Furthermore, the results support the practice of having medical students conduct psychotherapy under supervision during their training.

scholarly journals Childhood sexual and physical abuse: age at exposure modulates impact on functional outcome in early psychosis patients

2015 ◽  
Vol 45 (13) ◽  
pp. 2727-2736 ◽  
Author(s):  
L. Alameda ◽  
C. Ferrari ◽  
P. S. Baumann ◽  
M. Gholam-Rezaee ◽  
K. Q. Do ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Social Functioning ◽  
Physical Abuse ◽  
Early Psychosis ◽  
Global Assessment Of Functioning ◽  
Functional Impairments ◽  
Functional Level ◽  
History Of ◽  
The Impact

BackgroundEvidence suggests a relationship between exposure to trauma during childhood and functional impairments in psychotic patients. However, the impact of age at the time of exposure has been understudied in early psychosis (EP) patients.MethodTwo hundred and twenty-five patients aged 18–35 years were assessed at baseline and after 2, 6, 18, 24, 30 and 36 months of treatment. Patients exposed to sexual and/or physical abuse (SPA) were classified according to age at the time of first exposure (Early SPA: before age 11 years; Late SPA: between ages 12 and 15 years) and then compared to patients who were not exposed to such trauma (Non-SPA). The functional level in the premorbid phase was measured with the Premorbid Adjustment Scale (PAS) and with the Global Assessment of Functioning (GAF) scale and the Social and Occupational Functioning Assessment Scale (SOFAS) during follow-up.ResultsThere were 24.8% of patients with a documented history of SPA. Late SPA patients were more likely to be female (p= 0.010). Comparison with non-SPA patients revealed that: (1) both Early and Late SPA groups showed poorer premorbid social functioning during early adolescence, and (2) while patients with Early SPA had poorer functional level at follow-up with lower GAF (p= 0.025) and lower SOFAS (p= 0.048) scores, Late SPA patients did not.ConclusionOur results suggest a link between exposure to SPA and the later impairment of social functioning before the onset of the disease. EP patients exposed to SPA before age 12 may present long-lasting functional impairment, while patients exposed at a later age may improve in this regard and have a better functional outcome.

Validity of childhood disintegrative psychosis

1998 ◽  
Vol 172 (3) ◽  
pp. 263-267 ◽  
Author(s):  
Svend Erik Mouridsen ◽  
Bente Rich ◽  
Torben Isager
Keyword(s):  
Global Assessment ◽  
Comparison Group ◽  
Diagnostic Category ◽  
Infantile Autism ◽  
Global Assessment Of Functioning ◽  
Separate Form ◽  
History Of ◽  
Diagnostic Label ◽  
Social Style

BackgroundEmpirical evidence for the validity of the diagnostic label ‘disintegrative psychosis' is sparse. The issue of whether it is a separate form of infantile autism is unresolved.MethodTo investigate the validity of disintegrative psychosis as defined in ICD–9, the natural history of 13 cases were compared with 39 matched cases of infantile autism on various outcome variables. Average follow-up time was 22 (11–33) years.ResultsStatistically significant differences were found between the two groups in terms of number of admissions to non-psychiatric departments, occurrence of comorbid epilepsy social style, and score on the Global Assessment of Functioning scale. In most other areas assessed there was a tendency, although statistically insignificant, towards a better outcome in the infantile autism comparison group.ConclusionsOur findings provide some support for maintaining a diagnostic category of disintegrative psychosis as distinct from infantile autism.

Therapists’ professional and personal characteristics as predictors of outcome in long-term psychodynamic psychotherapy and psychoanalysis

2014 ◽  
Vol 29 (5) ◽  
pp. 265-274 ◽  
Author(s):  
E. Heinonen ◽  
P. Knekt ◽  
T. Jääskeläinen ◽  
O. Lindfors
Keyword(s):  
Psychiatric Symptoms ◽  
Personal Characteristics ◽  
Severity Index ◽  
Therapist Characteristics ◽  
Work Experiences ◽  
Global Severity Index ◽  
Quasi Experimental ◽  
Pre Treatment

AbstractBackground:Whether long-term psychodynamic therapy (LPP) and psychoanalysis (PA) differ from each other and require different therapist qualities has been debated extensively, but rarely investigated empirically.Methods:In a quasi-experimental design, LPP was provided for 128 and PA for 41 outpatients, aged 20–46 years and suffering from mood or anxiety disorder, with a 5-year follow-up from start of treatment. Therapies were provided by 58 experienced therapists. Therapist characteristics, measured pre-treatment, were assessed with the Development of Psychotherapists Common Core Questionnaire (DPCCQ). General psychiatric symptoms were assessed as the main outcome measure at baseline and yearly after start of treatment with the Symptom Check List, Global Severity Index (SCL-90-GSI).Results:Professionally less affirming and personally more forceful and less aloof therapists predicted less symptoms in PA than in LPP at the end of the follow-up. A faster symptom reduction in LPP was predicted by a more moderate relational style and work experiences of both skillfulness and difficulties, indicating differences between PA and LPP in the therapy process.Conclusions:Results challenge the benefit of a classically “neutral” psychoanalyst in PA. They also indicate closer examinations of therapy processes within and between the two treatments, which may benefit training and supervision of therapists.

Assessing Stressors Related to Migration in Patients With Psychiatric Disorders

2012 ◽  
Vol 28 (4) ◽  
pp. 262-269 ◽  
Author(s):  
Matthias Johannes Müller ◽  
Suzan Kamcili-Kubach ◽  
Songül Strassheim ◽  
Eckhardt Koch
Keyword(s):  
Interrater Reliability ◽  
Item Analysis ◽  
Global Assessment Of Functioning ◽  
Family Conflicts ◽  
Response Options ◽  
Reliability Indices ◽  
Dsm Iv ◽  
Functional Relevance ◽  
Sum Scores ◽  
Gaf Scores

A 10-item instrument for the assessment of probable migration-related stressors was developed based on previous work (MIGSTR10) and interrater reliability was tested in a chart review study. The MIGSTR10 and nine nonspecific stressors of the DSM-IV Axis IV (DSMSTR9) were put into a questionnaire format with categorical and dimensional response options. Charts of 100 inpatients (50 Turkish migrants [MIG], 50 native German patients [CON]) with affective or anxiety disorder were reviewed by three independent raters and MIGSTR10, DSMSTR9, and Global Assessment of Functioning scale (GAF) scores were obtained. Interrater reliability indices (ICC) of items and sum scores were calculated. The prevalence of single migration-related stressors in MIG ranged from 15% to 100% (CON 0–92%). All items of the MIGSTR10 (ICC 0.58–0.92) and the DSMSTR9 (ICC 0.56–0.96) reached high to very high interrater agreement (p < .0005). The item analysis of the MIGSTR10 revealed sufficient internal consistency (Cronbach’s α = 0.68/0.69) and only one item (“family conflicts”) without substantial correlation with the remaining scale. Correlation analyses showed a significant overlap of dimensional MIGSTR10 scores (r² = 0.25; p < .01) and DSMSTR9 scores (r² = 9%; p < .05) with GAF scores in MIG indicating functional relevance. MIGSTR10 is considered a feasible, economic, and reliable instrument for the assessment of stressors potentially related to migration.

scholarly journals Oral Tranexamic Acid for the Treatment of Melasma

2014 ◽  
Vol 10 (4) ◽  
pp. 40-43 ◽  
Author(s):  
D Karn ◽  
S KC ◽  
A Amatya ◽  
EA Razouria ◽  
M Timalsina
Keyword(s):  
Tranexamic Acid ◽  
Controlled Trial ◽  
Severity Index ◽  
Sustained Improvement ◽  
Treatment Measures ◽  
Group A ◽  
Group B ◽  
Novel Concept ◽  
High Treatment

Background Melasma poses a great challenge as its treatment is unsatisfactory and recurrence is high. Treatment of melasma using tranexamic acid (oral, topical or intralesional) is a novel concept. Objective To compare the efficacy of oral tranexamic acid with routine topical therapies for the treatment of melasma. Methods It is a prospective, interventional, randomized controlled trial conducted among 260 melasma patients. Patients were divided into two groups consisting of 130 patients each. First group (Group A) was given routine treatment measures and oral Tranexamic Acid while second group (Group B) was treated only with routine topical measures. Capsule Tranexamic Acid was prescribed at a dose of 250 mg twice a day for three months and cases were followed for three months. Response was evaluated on the basis of Melasma Assessment Severity Index (MASI). Mean scores between the two groups were then compared. Results Statistically significant decrease in the mean Melasma Assessment Severity Index from baseline to 8 and 12 weeks was observed among group A patients (11.08±2.91 vs 8.95±2.08 at week 8 and vs. 7.84±2.44 at week 12; p<0.05 for both). While among group B patients the decrease in mean score was significant at 8 weeks and insignificant at 12 weeks follow up (11.60±3.40 vs 9.9±2.61 at 8 weeks and vs. 9.26±3 at 12 weeks; p<0.05 for former but p>0.05 for later). Conclusion Addition of oral tranexamic acid provides rapid and sustained improvement in the treatment of melasma. DOI: http://dx.doi.org/10.3126/kumj.v10i4.10993 Kathmandu Univ Med J 2012;10(4):40-43

scholarly journals Persistent level of mental distress in PTSD patients is not reflected in cytokine levels one year after treatment

2021 ◽  
pp. 1-22
Author(s):  
Helge Toft ◽  
Jørgen Bramness ◽  
Terje Tilden ◽  
Ingeborg Bolstad ◽  
Lars Lien
Keyword(s):  
Inflammatory Markers ◽  
Mental Distress ◽  
Psychiatric Treatment ◽  
Blood Collection ◽  
Post Traumatic Stress ◽  
Global Severity Index ◽  
Cytokine Levels ◽  
One Year ◽  
Circulating Inflammatory Markers

Abstract Objective Cross-sectional data show that Post-Traumatic Stress Disorder (PTSD) patients often have increased levels of circulating inflammatory markers. There is, however, still a paucity of longitudinal studies with long follow-up times on levels of cytokines in such patients. The current study assesses patients with and without PTSD diagnosis one year after discharge from inpatient treatment. Methods Patients in treatment for serious non-psychotic mental disorders were recruited at the beginning of their treatment stay at a psychiatric center in Norway. Ninety patients submitted serum samples and filled out the Hopkins Symptom Checklist-90 Revised Global Severity Index (HSCL-90R GSI) questionnaire during their main stay and at a follow-up stay one year after discharge. Of these patients, 33 were diagnosed with PTSD, 48 with anxiety, depression or eating disorder, while nine patients had missing data. The patients were diagnosed using the Mini-International Neuropsychiatric Interview (M.I.N.I.). Results At the follow-up stay (T3), PTSD patients had higher levels of GSI scores than non-PTSD patients (p = 0.048). These levels were unchanged from the year before (T2) in both groups. The levels of circulating cytokines/chemokine did not differ between the PTSD and non-PTSD patients at T3. At T2, however, the PTSD and non-PTSD groups exhibited different levels of IL-1β (p = 0.053), IL-1RA (p = 0.042) and TNF-α (p = 0.037), with the PTSD patients having the higher levels. Conclusion Despite exhibiting different mental distress scores, the PTSD and non-PTSD patients did not differ regarding levels of circulating inflammatory markers at one-year follow-up. Significant outcome PTSD and non-PTSD patients show persistently different scores of mental distress one year after psychiatric treatment. In contrast, their cytokine levels do not differ one year after discharge from a psychiatric treatment inpatient stay. Limitations The patients with higher scores of mental distress were those who attended the follow-up stay, introducing a selection bias to the study. Further, it was not assessed whether the patients were fasting or smoking cigarettes prior to blood collection, or their sleeping or physical exercise status.

scholarly journals Laminoplasty with selective fusion at unstable segment versus laminectomy with fusion for multilevel cervical myelopathy: a case‐control study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Lin Du ◽  
Yanzheng Gao ◽  
Changqing Zhao ◽  
Tangjun Zhou ◽  
Haijun Tian ◽  
...  
Keyword(s):  
Symptom Severity ◽  
Cervical Myelopathy ◽  
Case Control Study ◽  
Case Control ◽  
Axial Symptom ◽  
Segmental Instability ◽  
Neurologic Status ◽  
Multilevel Cervical Myelopathy ◽  
Control Study

Abstract Background Segmental cervical instability is a risk factor for the progression of osteophytic bone spurs and development of myelopathy, and is treated as a relative contraindication of cervical laminoplasty. The aim of this study was to compare laminoplasty with selective fixation (LPSF) versus laminectomy with fusion (LCF) in patients with multilevel cervical myelopathy accompanied by segmental instability. Methods A case-control study was conducted by reviewing data from 63 patients who underwent LPSF (n = 30) or LCF (n = 33). Cervical alignment, range of motion (ROM), neurologic status and axial symptom severity pre-operation, 3-days after operation, and at the final follow-up (minimum 24 months) were measured and compared between groups. Results Postoperation, patients in the LPSF group lost 31.1 ± 17.3 % of cervical lordosis and 43.2 ± 10.9 % cervical ROM while patients in the LCF group lost 5.7 ± 8.2 % and 67.9 ± 15.5 %, respectively. Both LPSF and LCF groups significantly improved neurologic status and axial symptom severity at the final follow-up with similar between-group results(P > 0.05). Blood loss, operation time, hospital stay, and medical cost in the LPSF group were significantly less than in the LCF group(P < 0.05). Conclusions In 2 years of clinical observation, LPSF was effective in maintaining the stability of the cervical spine with less sacrifice of mobility and surgical trauma for multilevel myelopathy with segmental instability compared to LCF.

scholarly journals Subclinical Cardiac Organ Damage in Patients with Moderate to Severe Psoriasis

2021 ◽  
Vol 10 (11) ◽  
pp. 2440
Author(s):  
Anja Linde ◽  
Eva Gerdts ◽  
Kåre Steinar Tveit ◽  
Ester Kringeland ◽  
Helga Midtbø
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
Treatment Initiation ◽  
Severity Index ◽  
Organ Damage ◽  
Left Ventricular ◽  
Infliximab Treatment ◽  
Increased Risk ◽  
Psoriasis Severity

We explored the association between subclinical cardiac organ damage (OD) with comorbidities and psoriasis severity in 53 psoriasis patients on infliximab treatment (age 47 ± 15 years, 30% women) and 99 controls without psoriasis (age 47 ± 11 years, 28% women). Cardiac OD was assessed by echocardiography as the presence of increased left ventricular (LV) relative wall thickness (RWT), LV hypertrophy or dilated left atrium. Psoriasis severity was graded using the psoriasis area and severity index (PASI). The prevalence of hypertension was 66% in psoriasis vs. 61% in controls (p = 0.54) and cardiac OD seen in 51 and 73%, respectively (p = 0.007). Psoriasis was associated with a lower prevalence of cardiac OD (odds ratio (OR) 0.32, 95% confidence interval (CI) 0.13–0.77, p = 0.01) independent of age, sex, smoking, body mass index, and hypertension. Among psoriasis patients, hypertension was associated with increased risk of subclinical cardiac OD (OR 6.88, 95% CI 1.32–35.98, p = 0.02) independent of age, sex, and body mass index. PASI at treatment initiation was associated with a higher RWT at follow-up, independent of sex, age, and hypertension (β 0.36, p = 0.006) while no association with current PASI was found. In conclusion, cardiac OD was less prevalent in psoriasis patients on infliximab treatment than controls. Hypertension was the major covariable for subclinical cardiac OD in psoriasis.

Evaluating Immediate and Short-Term Postoperative Clinical Outcomes of Patients Undergoing Ulnar Shortening for Ulnar Impaction Syndrome Using PROMIS

2021 ◽  
Author(s):  
David N. Bernstein ◽  
Richard D. Lander ◽  
Warren C. Hammert
Keyword(s):  
Symptom Severity ◽  
Operative Management ◽  
Short Term ◽  
Appreciable Change ◽  
Preoperative Visit ◽  
Ulnar Impaction ◽  
Patient Reported ◽  
Average Change ◽  
Ulnar Impaction Syndrome

Abstract Background The early recovery trajectory of patients undergoing ulnar shortening for ulnar impaction syndrome using the Patient-Reported Outcomes Measurement Information System (PROMIS) is unknown. Questions/Purposes Using PROMIS Upper Extremity (UE), Physical Function (PF), Pain Interference (PI), and Depression, we asked (1) do patients undergoing operative management for ulnar impaction syndrome present at their preoperative visit with notable impairment?; (2) At immediate follow-up, do patients present with a clinically appreciable change in symptom severity?; and (3) At short-term follow-up, do patients present with a clinically appreciable change in symptom severity? Patients and Methods We identified patients from 01/2017 to 12/2019 at our institution undergoing ulnar shortening for ulnar impaction syndrome who completed all PROMIS domains at a preoperative visit and at least one postoperative time point (i.e., less than 4 weeks and/or greater than 12 weeks). Distribution- and anchor-based minimal clinically important difference estimates were used to evaluate clinically appreciable changes in symptoms over time. Results A total of 38 patients met our inclusion criteria. The average change in PROMIS UE, PF, PI, and Depression scores from preoperative to immediate postoperative follow-up were –3.8, –4.3, 3.2, and 0.5, respectively. However, by short-term follow-up, the average change in PROMIS UE, PF, PI, and Depression scores were 3.7, 3.2, –4.7, and –3.9, respectively. Conclusions Patients have worsening function at the immediate postoperative follow-up. By short-term postoperative follow-up, functional status and PI levels improve. Our findings can help hand surgeons provide evidence-based guidance on expected initial recovery following operative management for ulnar impaction syndrome. Level of Evidence This is a level II, prognostic study.

Sign in / Sign up

Export Citation Format

Share Document