Face to face with the suicidal

The clinical assessment and management of suicide risk depends primarily on face to face contact with the individual who presents the risk, and aims to predict behaviour in the very near future. Whether or not clinical intervention prevents suicide depends a great deal on the clinician's skill in reaching out to the individual patient. This poses a dilemma, because much of what has been written about predicting suicide has been based on averaged data concerning long-term outcome in large cohorts of patients.

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Psychopathology 8½ Years Post Parasuicide

Crisis ◽

10.1027//0227-5910.20.3.115 ◽

1999 ◽

Vol 20 (3) ◽

pp. 115-120 ◽

Cited By ~ 9

Author(s):

Stephen Curran ◽

Michael Fitzgerald ◽

Vincent T Greene

Keyword(s):

Rating Scales ◽

Psychiatric Morbidity ◽

Parental Bonding ◽

Social Maladjustment ◽

Term Outcome ◽

Long Term Outcome ◽

Face To Face ◽

Long Term Follow Up

There are few long-term follow-up studies of parasuicides incorporating face-to-face interviews. To date no study has evaluated the prevalence of psychiatric morbidity at long-term follow-up of parasuicides using diagnostic rating scales, nor has any study examined parental bonding issues in this population. We attempted a prospective follow-up of 85 parasuicide cases an average of 8½ years later. Psychiatric morbidity, social functioning, and recollections of the parenting style of their parents were assessed using the Clinical Interview Schedule, the Social Maladjustment Scale, and the Parental Bonding Instrument, respectively. Thirty-nine persons in total were interviewed, 19 of whom were well and 20 of whom had psychiatric morbidity. Five had died during the follow-up period, 3 by suicide. Migration, refusals, and untraceability were common. Parasuicide was associated with parental overprotection during childhood. Long-term outcome is poor, especially among those who engaged in repeated parasuicides.

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THE INDIVIDUAL TAILORING OF IMMUNOSUPPRESSIVE THERAPY AFTER HEART TRANSPLANTATION

Russian Journal of Transplantology and Artificial Organs ◽

10.15825/1995-1191-2018-1-127-137 ◽

2018 ◽

Vol 20 (1) ◽

pp. 127-137

Author(s):

N. N. Koloskova ◽

V. N. Poptsov ◽

A. О. Shevchenko

Keyword(s):

Heart Transplantation ◽

Immunosuppressive Therapy ◽

Severe Heart Failure ◽

Direct Effects ◽

Transplant Recipients ◽

Term Outcome ◽

Long Term Outcome ◽

Post Transplant ◽

The Individual

Heart transplantation is the «gold standard» of treatment severe heart failure. Immunosuppressive therapy aimed at the prevention of acute allograft rejection is the cornerstone of post-transplant management. In addition to its direct effects, immunosuppressive therapy is also involved in the generation of a number of post-transplant morbidities that limit the long-term outcome of heart transplant recipients. Given these data it appears that the individual tailoring of immunosuppressive therapy is of paramount importance in determining the outcome of heart transplantation. The goal of immunosuppressive therapy is to prevent rejection of the transplanted heart, while minimizing drug-related effects, such as infection, malignancy, diabetes, hypertension, and renal insuffi ciency. This review aimed is to analyze the protocols for the appointment of immunosuppressive therapy in various groups of recipients after heart transplantation.

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Testing non-inferiority of blended versus face-to-face Cognitive Behavioural Therapy for severe fatigue in patients with Multiple Sclerosis and the effectiveness of blended booster sessions aimed at improving long term outcome following both therapies: – study protocol for two observer-blinded randomized clinical trials

10.21203/rs.2.12515/v2 ◽

2019 ◽

Author(s):

Marieke Houniet- de Gier ◽

Heleen Beckerman ◽

Kimberley van Vliet ◽

Hans Knoop ◽

Vincent de Groot

Keyword(s):

Clinical Trials ◽

Behavioural Therapy ◽

Term Outcome ◽

Long Term Outcome ◽

Face To Face ◽

Cognitive Behavioural ◽

End Of Treatment ◽

Booster Sessions ◽

Fatigue Severity

Abstract Background: Cognitive behavioural therapy (CBT) has been found effective in reducing fatigue severity in MS patients directly following treatment. However, long-term effects are inconsistent leaving room for improvement. In addition, individual face-to-face CBT draws heavily on limited treatment capacity, and the travel distance to the treatment centre can be burdensome for patients. Therefore, we developed “MS Fit”, a blended CBT for MS-related fatigue, based on a face-to-face CBT protocol found effective in a previous study, and “MS Stay Fit”, internet-based booster sessions to improve long term effectiveness of CBT for MS-related fatigue. This paper presents the protocol of two Randomised Clinical Trials (RCTs) conducted within one study investigating 1) the non-inferiority of MS Fit compared to evidence-based face-to-face CBT for MS-related fatigue, and 2) the effectiveness of MS Stay Fit on the long-term outcome of fatigue compared to no booster sessions. Methods/design: The first part of this study is an observer-blinded non-inferiority multicentre RCT, in which 166 severely fatigued MS patients will be randomized (1:1 ratio, computer-generated sequence) to either face-to-face CBT or blended CBT (MS Fit) for fatigue. The primary endpoint is at 20 weeks after baseline. After this post-treatment assessment, patients will be randomized again (1:1 ratio, computer generated sequence) to either MS Stay Fit consisting of 2 booster sessions at 2 and 4 months after end of treatment, or no booster sessions. The primary endpoint of the second study is 52 weeks after baseline. Primary outcome measure in both studies is fatigue severity assessed with the fatigue severity subscale of the Checklist Individual Strength (CIS20r). Outcomes will be assessed at baseline (T0), end of treatment (T20), after 39 and 52 weeks (T39 and T52). Discussion: If MS Fit is found to be non-inferior to face-to-face CBT it will improve the accessibility of this treatment. In addition, the study aims to test if it is possible to improve long-term effectiveness of CBT for MS-related fatigue with MS Stay Fit.

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Testing non-inferiority of blended versus face-to-face Cognitive Behavioural Therapy for severe fatigue in patients with Multiple Sclerosis and the effectiveness of blended booster sessions aimed at improving long term outcome following both therapies: – study protocol for two observer-blinded randomized clinical trials

10.21203/rs.2.12515/v1 ◽

2019 ◽

Author(s):

Marieke Houniet- de Gier ◽

Heleen Beckerman ◽

Kimberley van Vliet ◽

Hans Knoop ◽

Vincent de Groot

Keyword(s):

Clinical Trials ◽

Behavioural Therapy ◽

Term Outcome ◽

Long Term Outcome ◽

Face To Face ◽

Cognitive Behavioural ◽

End Of Treatment ◽

Booster Sessions ◽

Fatigue Severity

Abstract Background Cognitive behavioural therapy (CBT) has been found effective in reducing fatigue severity in MS patients directly following treatment. However, long-term effects are inconsistent leaving room for improvement. In addition, individual face-to-face CBT draws heavily on limited treatment capacity, and the travel distance to the treatment centre can be burdensome for patients. Therefore, we developed “MS Fit”, a blended CBT for MS-related fatigue, based on a face-to-face CBT protocol found effective in a previous study, and “MS Stay Fit”, internet-based booster sessions to improve long term effectiveness of CBT for MS-related fatigue. This paper presents the protocol of two Randomised Clinical Trials (RCTs) conducted within one study investigating 1) the non-inferiority of MS Fit compared to evidence-based face-to-face CBT for MS-related fatigue, and 2) the effectiveness of MS Stay Fit on the long-term outcome of fatigue compared to no booster sessions. Methods/design The first part of this study is an observer-blinded non-inferiority multicentre RCT, in which 166 severely fatigued MS patients will be randomized (1:1 ratio, computer-generated sequence) to either face-to-face CBT or blended CBT (MS Fit) for fatigue. The primary endpoint is at 20 weeks after baseline. After this post-treatment assessment, patients will be randomized again (1:1 ratio, computer generated sequence) to either MS Stay Fit consisting of 2 booster sessions at 2 and 4 months after end of treatment, or no booster sessions. The primary endpoint of the second study is 52 weeks after baseline. Primary outcome measure in both studies is fatigue severity assessed with the fatigue severity subscale of the Checklist Individual Strength (CIS20r). Outcomes will be assessed at baseline (T0), end of treatment (T20), after 39 and 52 weeks (T39 and T52). Discussion If MS Fit is found to be non-inferior to face-to-face CBT it will improve the accessibility of this treatment. In addition, the study aims to test if it is possible to improve long-term effectiveness of CBT for MS-related fatigue with MS Stay Fit.

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