scholarly journals Beginning therapy: clinical outcomes in brief treatments by psychiatric trainees

2006 ◽  
Vol 30 (1) ◽  
pp. 7-10 ◽  
Author(s):  
Chris Mace ◽  
Sally Beeken ◽  
Joan Embleton
Keyword(s):  
Psychodynamic Therapy ◽  
Post Treatment ◽  
Clinical Implications ◽  
Retrospective Case ◽  
Data Matching ◽  
Treatment Changes ◽  
Analytic Therapy ◽  
Severe Pathology ◽  
Cognitive Analytic Therapy

Aims and MethodPsychotherapy provided by inexperienced psychiatric trainees was assessed through comparison of post-treatment outcomes with a brief psychodynamic therapy and a brief integrative psychotherapy. A retrospective case–control design was applied to all patients seen by nine senior house officers (SHOs) during 6-month placements who provided follow-up data. Matching linked each patient offered simple cognitive–analytic therapy to one who had received brief psychodynamic therapy from the same SHO. Post-treatment changes were analysed by treatment received and differences between trainees were explored.ResultsSeventeen cases in each group met entry criteria. Patients receiving the integrative treatment had more severe pathology and outcomes were more variable when this model was used. Eight of the nine SHO therapists performed better with the psychodynamic intervention.Clinical ImplicationsSignificant clinical improvements can be achieved by inexperienced psychiatric trainees providing brief psychotherapy under supervision. Patient selection is undoubtedly important. Fundamental psychotherapy competencies need to be mastered before structured hybrid models are attempted.

scholarly journals Behavioural Management of Headache Triggers: Three Case Examples Illustrating a New Effective Approach (Learning to Cope with Triggers)

2015 ◽  
Vol 32 (3) ◽  
pp. 202-208 ◽  
Author(s):  
Paul R. Martin ◽  
Moira Callan ◽  
Archana Kaur ◽  
Karen Gregg
Keyword(s):  
Traditional Approach ◽  
Tension Type Headache ◽  
Post Treatment ◽  
Case Examples ◽  
Medication Consumption ◽  
Alternative Approach ◽  
Treatment Changes ◽  
Type Headache ◽  
Behavioural Management

The traditional approach to headache trigger management is to advise avoidance of all triggers, but we have advocated an alternative approach called ‘Learning to Cope with Triggers’ (LCT), in which the objective is to desensitise headache sufferers to some triggers or to build up tolerance for the triggers, using exposure techniques. A recent publication established the efficacy of this approach to trigger management. Reported here are three cases to illustrate how LCT is used in practice. Two cases were male and one was female, with ages ranging from 32 to 67 years. The headache diagnoses were frequent episodic tension-type headache, migraine without aura, and chronic tension-type headache; all had had headaches since childhood/adolescence. The headache triggers that were the focus of the intervention were heat, tiredness, and stress/anger. Post-treatment, changes in the capacity of the triggers to elicit headaches were reported in all three cases. Reductions in headaches from pre- to post-treatment, and from pre- to 4-month follow-up, were: case 1, 69% and 60% respectively; case 2, 76% and 80% respectively; and case 3, 73% and 61% respectively. Decreases in medication consumption, and enhanced self-efficacy were also recorded.

Heterogeneity of treatment changes after psychodynamic therapy within a one year follow-up: A replication study

2014 ◽  
Vol 55 (2) ◽  
pp. 168-179 ◽  
Author(s):  
Hans Henrik Jensen ◽  
Erik Lykke Mortensen ◽  
Martin Lotz
Keyword(s):  
Psychodynamic Therapy ◽  
Replication Study ◽  
Treatment Changes ◽  
One Year

scholarly journals Should old age psychiatry develop memory clinics? A comparison with domiciliary work

2004 ◽  
Vol 28 (3) ◽  
pp. 78-82 ◽  
Author(s):  
S. Simpson ◽  
D. Beavis ◽  
J. Dyer ◽  
S. Ball
Keyword(s):  
Old Age ◽  
Clinical Implications ◽  
Memory Clinic ◽  
Retrospective Case ◽  
Memory Clinics ◽  
Old Age Psychiatry ◽  
Psychiatric Complications ◽  
To Receive ◽  
Case Note Review

Aims and MethodMemory clinics have become very popular in old age psychiatry and there is some pressure for them to be developed in old age services. However, there is little evidence to suggest that they are more advantageous over the traditional domiciliary visits or who should be seen in clinic. This was a naturalistic comparison of 76 consecutive new referrals to a memory clinic, with 74 consecutive new domiciliary requests within the same service over the same period of time. A retrospective case note review collected the clinical features and an 18-month prospective follow-up examined the subsequent clinical management.Clinical ImplicationsThe two groups were characterised more by their similarities than their differences. However, the domiciliary group had greater behavioural and psychological complications. The memory clinic patients were less likely to receive psychotropic medication and here more likely to be followed up.ResultsWe conclude that memory clinics might be less suitable for patients with prominent psychiatric complications. Memory clinics could complement the domiciliary model by providing early psychosocial/neuropsychiatric approaches, although this is likely to lead to an increased clinical case-load.

scholarly journals A repeat audit of the Cognitive Analytic Therapy Clinic at Guy's Hospital

1997 ◽  
Vol 21 (3) ◽  
pp. 165-168 ◽  
Author(s):  
Mark Dunn ◽  
Katya Golynkina ◽  
Anthony Ryle ◽  
J. P. Watson
Keyword(s):  
Drop Out ◽  
Drop Out Rate ◽  
Training And Supervision ◽  
Analytic Therapy ◽  
Cognitive Analytic Therapy ◽  
Therapy Clinic

A repeat audit of referrals to the CAT Clinic of Guy's Hospital is reported. Changes in training and supervision of therapists instituted since earlier audits are believed to have contributed to a lower drop-out rate and a higher attendance for follow-up. Mean score reductions on three questionnaires are significant and consistent in the three cohorts. Some characteristics of samples of patients who dropped out and failed to attend for follow up are described.

A New Methodology of Assessing Adult Attachment: Exploring its Validity and Clinical Relevance

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
A. Sochos ◽  
S. Smith ◽  
H. Davies ◽  
V. Heidel
Keyword(s):  
Clinical Relevance ◽  
Interpersonal Problems ◽  
Brief Symptom Inventory ◽  
Inventory Of Interpersonal Problems ◽  
Attachment Research ◽  
Analytic Therapy ◽  
Attachment Dimensions ◽  
Cognitive Analytic Therapy ◽  
Preliminary Support

Aims:Attachment research has provided useful concepts towards an interpersonal approach to psychopathology. Although it suggests that psychological processes are defined by three relational dichotomies (self vs. other, relatedness vs. autonomy, and dependent vs. dependent-on positions), it has not yet assessed separately and simultaneously the eight components generated by the intersection of these dichotomies (e.g. self requesting relatedness, self providing relatedness etc). The aim of the present research was to investigate the validity and potential clinical usefulness of such a neglected approach.Methods:In Study 1, thirty Cognitive Analytic Therapy outpatients at Guy's Hospital, London, were interviewed before treatment on their couple relationships and filled out the Brief Symptom Inventory (BSI) and Inventory of Interpersonal Problems (IIP). A content-analytic method was applied to the transcripts. In Study 2, a new attachment questionnaire was completed by 400 undergraduates, along with the BSI and IIP.Results:In Study 1, at a six-month follow-up, BSI scores were predicted by the Self Requests Autonomy [R Sq = .29, F(1,23) = 10.84, p = .003] and the Other Provides Closeness [R Sq = .23, F(1,23) = 9.72, p=.001] attachment dimensions, while IIP scores were predicted by Self Provides Support [R Sq = .11, F(1,23) = 7.87, p=.003]. In Study 2, factor analysis yielded eight components matching the theoretical expectations and correlating with BSI and IIP scores (rs ranging from .18 to.41).Conclusions:The present findings provide some preliminary support for the validity and potential clinical relevance of the method.

scholarly journals The Effect of Patient’s Choice of Cognitive Behavioural or Psychodynamic Therapy on Outcomes for Panic Disorder: A Doubly Randomised Controlled Preference Trial

2020 ◽  
pp. 1-12
Author(s):  
Martin Svensson ◽  
Thomas Nilsson ◽  
Sean Perrin ◽  
Håkan Johansson ◽  
Gardar Viborg ◽  
...  
Keyword(s):  
Panic Disorder ◽  
Psychodynamic Therapy ◽  
Post Treatment ◽  
Work Status ◽  
Random Assignment ◽  
Treatment Assessment ◽  
Cognitive Behavioural ◽  
Randomised Controlled ◽  
Preference Trial

<b><i>Introduction:</i></b> It remains unclear whether offering psychiatric patients their preferred treatment influences outcomes at the symptom level. <b><i>Objective:</i></b> To assess whether offering patients with panic disorder with/without agoraphobia (PD/A) a choice between 2 psychotherapies yields superior outcomes to random assignment. <b><i>Methods:</i></b> In a doubly randomised, controlled preference trial (DRCPT), 221 adults with PD/A were randomly assigned to: choosing panic-focused psychodynamic therapy (PFPP) or panic control treatment (PCT; a form of cognitive behavioural therapy); random assignment to PFPP or PCT; or waiting list control. Primary outcomes were PD/A severity, work status and work absences at post-treatment assessment. Outcomes at post-treatment assessment, 6-, 12-, and 24-month follow-ups were assessed using segmented multilevel linear growth models. <b><i>Results:</i></b> At post-treatment assessment, the choice and random conditions were superior to the control for panic severity but not work status/absences. The choice and random conditions did not differ during treatment or follow-up for the primary outcomes. For panic severity, PCT was superior to PFPP during treatment (standardised mean difference, SMD, –0.64; 95% confidence interval, CI, –1.02 to –0.25); PFPP was superior to PCT during follow-up (SMD 0.62; 95% CI 0.27–0.98). There was no allocation by treatment type interaction (SMD –0.57; 95% CI –1.31 to 0.17). <b><i>Conclusions:</i></b> Previous studies have found that offering patients their preferred treatment yields small to moderate effects but have not employed designs that could rigorously test preference effects. In this first DRCPT of 2 evidence-based psychotherapies, allowing patients with PD/A to choose their preferred treatment was not associated with improved outcomes. Further DRCPTs are needed.

scholarly journals Clinical efficacy of Tailin formulation combined with continuous low-dose antimicrobial therapy for recurrent urinary tract infection: study protocol for a multicenter, double-blind, randomized, controlled clinical trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Tonglu Li ◽  
Yingru Xu ◽  
Xuezhong Gong
Keyword(s):  
Clinical Trial ◽  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Post Treatment ◽  
Controlled Clinical Trial ◽  
Double Blind ◽  
Randomized Controlled ◽  
Treatment Changes

Abstract Background Given the increasing rates of antimicrobial resistance (AMR), recurrent urinary tract infection (rUTI) is becoming refractory more and more. Antibiotic prophylaxis including continuous low-dose antibiotic therapy (CLAT), is the common treatment for rUTI of the world. However, the presumably adverse reactions caused by CLAT alone should be paid more attention. Studies indicated that Chinese herbal medicine (CHM) might be an available treatment method for rUTI. Tailin formulation (TLF) is a herbal prescription developed for the treatment of rUTI in the 2000s in Shanghai Municipal Hospital of Traditional Chinese Medicine. Our previous studies have shown TLF could prevent urinary tract infection both in pyelonephritis (PN) rat model and in PN patients. Additionally, our published data demonstrated TLF is helpful to reduce the recurrence of rUTI and protect renal tubular function in clinic. In order to find a novel treating project for rUTI to increase the clinical curative effect, we thus try to combine TLF with CLAT to treat rUTI and design an optimized, pragmatically clinical trial to evaluate the efficacy and safety of this project. Methods/design This is a multicenter, double-blind, randomized, controlled clinical trial. We will enroll 200 eligible patients diagnosed with uncomplicated rUTI and then divide them randomly into two groups with a 1:1 ratio: TLF + CLAT group and placebo + CLAT group. This trial consists of two stages, a 12-week period of treatment and a 12-week period of post-treatment follow-up, respectively. The primary outcome will be the recurrence rate at the 12th week of the follow-up period; the second outcomes will be the post-treatment changes in renal and liver function; furthermore, traditional Chinese medicine (TCM) symptoms, non-infection-related physical signs, and subjective symptoms will be scored, and the number of episodes of each subject will be also recorded; meanwhile, vital signs indicators and serious adverse events (SAEs) will be monitored throughout the trial. Discussion This study will provide convictive research-derived data to evaluate clinical efficacy and safety of TLF combined with CLAT for rUTI, and provide an evidence-based recommendation for clinicians. Moreover, post-treatment changes in non-infection-related physical signs and subjective symptoms were included in the efficacy evaluation, which is important and more significant for assessing the clinical benefits for those rUTI patients. Trial registration Chinese Clinical Trial Registry ChiCTR2100041914. Registered on 10 January 2021. Protocol date and version: September 12, 2020; version 1.

Psychodynamic therapy for adolescents suffering from co-morbid disorders of conduct and emotions in an in-patient setting: a randomized controlled trial

2013 ◽  
Vol 44 (10) ◽  
pp. 2213-2222 ◽  
Author(s):  
S. Salzer ◽  
C. Cropp ◽  
U. Jaeger ◽  
O. Masuhr ◽  
A. Streeck-Fischer
Keyword(s):  
Randomized Controlled Trial ◽  
Treatment Group ◽  
Controlled Trial ◽  
Academic Failure ◽  
Psychodynamic Therapy ◽  
Post Treatment ◽  
Control Group ◽  
Global Severity Index ◽  
Randomized Controlled

BackgroundCo-morbid disorders of conduct and emotions can be regarded as childhood antecedents of further negative developments (e.g. manifestation of personality disorders in adulthood). We evaluated a manualized psychodynamic therapy (PDT) for adolescents with these co-morbid disorders.MethodIn a randomized controlled trial (RCT), 66 adolescents diagnosed with mixed disorders of conduct and emotions (F92 in ICD-10) were randomly assigned to a manualized in-patient PDT group or a waiting list/treatment-as-usual (WL/TAU) control condition. Diagnoses according to DSM-IV were also documented. Patients were compared using rates of remission as the primary outcome. The Global Severity Index (GSI) and the Strengths and Difficulties Questionnaire (SDQ) were used as secondary measures. Assessments were performed at baseline, post-treatment and at the 6-month follow-up.ResultsThe sample consisted of severely impaired adolescents with high rates of further co-morbid disorders and academic failure. Patients in the treatment group had a significantly higher rate of remission [odds ratio (OR) 26.41, 95% confidence interval (CI) 6.42–108.55, p < 0.001]. Compared with the control group, the PDT group resulted in significantly better outcomes on the SDQ (p = 0.04) but not the GSI (p = 0.18), with small between-group effect sizes (SDQ: d = 0.38, GSI: d = 0.18). However, the scores of patients treated with PDT were post-treatment no longer significantly different from normative data on the GSI and within the normal range on the SDQ. The effects in the treatment group were stable at follow-up. Furthermore, most patients were reintegrated into educational processes.ConclusionPDT led to remarkable improvement and furthered necessary preconditions for long-term stabilization. In future, PDT should be compared to other strong active treatments.

scholarly journals Changes in the anaclitic-introjective personality configurations following psychoanalytic psychotherapy with young adults

2017 ◽  
Vol 20 (1) ◽  
Author(s):  
Andrzej Werbart ◽  
Siri Aldèn ◽  
Anders Diedrichs
Keyword(s):  
Young Adults ◽  
Treatment Efficacy ◽  
Intraclass Correlation ◽  
Post Treatment ◽  
Psychoanalytic Psychotherapy ◽  
Clinical Implications ◽  
Treatment Goals ◽  
Symptom Checklist ◽  
Prototype Matching

Treatment goals in psychoanalytic psychotherapy often include changes in underlying psychological structures, rather than only symptom reduction. This study examines changes in the anaclitic-introjective personality configurations following psychoanalytic psychotherapy with young adults in relation to outcomes. Thirty-three patients were interviewed pretreatment and at termination using the Object Relations Inventory (ORI). Prototype Matching of Anaclitic-Introjective Personality Configuration (PMAI) was applied to the ORI material by two independent judges (intraclass correlation coefficient=0.73). The patients were classified pretreatment as predominately anaclitic (n=13) or introjective (n=20). Outcome measures included the Symptom Checklist-90-R (SCL-90) and Differentiation-Relatedness scale (D-R) pretreatment, at termination, at the 1.5-year and three-year follow-up. Both groups improved post-treatment in terms of symptoms and developmental levels of representations of self, mother, and father. No significant differences between the anaclitic and the introjective group were found in this respect, and could not be expected due to the low power (0.27). The anaclitic group showed better balance between relatedness and self-definition post-treatment, while this improvement was not significant in the introjective group. Further and larger studies are needed to draw more farreaching conclusions about the relations between changes in personality configurations over the course of treatment and the treatment efficacy. The clinical implications of this approach to underlying dynamic psychological structures are discussed.

scholarly journals Appearance of recurrent adult fibrosarcoma of the soft tissue and loco-regional post-treatment changes on MRI follow-up

2020 ◽  
Author(s):  
Sam Sedaghat ◽  
Frederick Schmitz ◽  
Anne Krieger ◽  
Maya Sedaghat ◽  
Benjamin Reichardt
Keyword(s):  
Soft Tissue ◽  
Post Treatment ◽  
Treatment Changes
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