A Comparison of Therapy Alone Versus Therapy and Medication in a Community Clinic

2005 ◽  
Vol 19 (4) ◽  
pp. 309-316 ◽  
Author(s):  
Jessica S. Brown ◽  
Nadia E. Stellrecht ◽  
Foluso M. Williams ◽  
Jillian M. Denoma ◽  
LaRicka R. Wingate ◽  
...  

Research to date suggests that the best treatment for many mental disorders is provided through the combination of medications and psychotherapy (e.g., Hollon, Thase, & Markowitz, 2002). However, the majority of studies supporting this point have been done utilizing highly restricted, controlled samples that may not accurately reflect the way mental illness is treated in the community. The present study attempted to replicate those findings in an outpatient community clinic. One hundred seventy-four adult clients who presented to a community clinic were rated as to their illness severity at both intake and termination of therapy using the Clinical Global Impression Scale and the Global Assessment of Functioning. These clients were divided into groups based on whether or not they took psychotropic medications at any point during therapy. Results showed that clients who took medications fared no better than clients who did not. These preliminary findings suggest that the combination of medications and psychotherapy may not be as effective in the “real world” as prior studies have implied, and point to the need for further research utilizing community samples.

2018 ◽  
Vol 51 ◽  
pp. 16-19 ◽  
Author(s):  
G. Pedersen ◽  
Ø. Urnes ◽  
B. Hummelen ◽  
T. Wilberg ◽  
E.H. Kvarstein

AbstractGlobal Assessment of Functioning (GAF) is a single measure of overall psychosocial impairment caused by mental factors, constituting Axis V of the Diagnostic and Statistical manual of Mental disorders, third and fourth versions. Despite its widespread use, several challenges and shortcomings have been discussed the last three decades. The current article describes some of the more serious challenges of the GAF manual, and presents a revised version more in accordance with the nature of this clinical construct. Some crucial aspects of the understanding of GAF and general guidelines for scoring are also discussed.


2012 ◽  
Vol 24 (6) ◽  
pp. 380-383 ◽  
Author(s):  
Manabu Takaki ◽  
Yuko Okahisa ◽  
Masafumi Kodama ◽  
Yutaka Mizuki ◽  
Shinji Sakamoto ◽  
...  

Takaki M, Okahisa Y, Kodama M, Mizuki Y, Sakamoto S, Ujike H, Uchitomi Y. Efficacy and tolerability of blonanserin in 48 patients with intractable schizophrenia.Background: Blonanserin is effective for the treatment of schizophrenia in Korea and Japan.Methods: We administered blonanserin to 48 Japanese patients with schizophrenia for whom other atypical antipsychotics were not sufficiently effective or tolerated.Results: Previous antipsychotics were replaced with blonanserin because of its effectiveness (54.2%; 26/48) or tolerability (45.8%; 22/48). Blonanserin was more effective in 65.4% (17/26) of the and better tolerated in 95.5% (21/22) of the patients. Of 48 patients, 33 continued blonanserin for 1 year. The mean Clinical Global Impression of Severity scores improved from 4.60 to 2.48. The mean Global Assessment of Functioning score improved from 29.8 to 51.7. Nineteen patients (39.6%; 19/48) had a social role. The reasons for discontinuation of blonanserin were ineffectiveness against psychosis (27.1%; 13/48) or intolerability (4.2%; 2/48). The ratio of discontinuation for intolerability versus ineffectiveness was 0.15, which was the lowest among atypical psychotics.Conclusions: Blonanserin may be effective and safe for the treatment of intractable schizophrenia.


2007 ◽  
Vol 12 (6) ◽  
pp. 1-4, 8 ◽  
Author(s):  
Norma Leclair ◽  
Steven Leclair ◽  
Robert Barth

Abstract The Global Assessment of Functioning (GAF) is part five of the multiaxial diagnostic system for mental disorders outlined in the Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition–Text Revised (DSM-IV-TR). The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) notes the use of DSM-IV-TR in rating an individual's global functional capacity, which, like disability, is related directly to the effects of impairments. The AMA Guides, Fourth and Fifth Editions, do not provide numeric psychiatric impairment, and shortcomings plague the use of GAF to define disability—but even so, authorities ranging from the State of California to the Veterans Administration rely on GAF scores. A table shows the 100-point scale Global Assessment Scale in which higher scores indicate better functioning. The GAF has been modified to address deficiencies; a decision tree has been added and is summarized; and the editor of DSM-IV-TR has developed a computerized version that reportedly improves reliability and validity. Evaluators should bear in mind that the GAF helps evaluate the individual's functioning in three areas: psychological, social, and occupational (including the activities of daily living). The resulting score facilitates the creation of a treatment plan, evaluates its effectiveness, and predicts outcomes, but evaluators should be aware of its significant limitations.


1992 ◽  
Vol 16 (5) ◽  
pp. 257-261 ◽  
Author(s):  
Roland Littlewood

Although relatively neglected in Britain, the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders has been widely adopted in both Western and non-Western countries (Spitzer, Williams & Skrodol, 1983). The descriptive and multiaxial approach used in DSM-III (1980) and in its revised edition DSM-III-R (1987), together with the introduction of specific criteria for allocating each diagnosis, would seem particularly useful when comparing psychopathologies across societies. In addition to Axes I, II and III (Clinical Syndromes, Developmental and Personality Disorders, Physical Disorders and Conditions), the Manual has two more obviously ‘social’ axes – (IV) Severity of Psychosocial Stressors and (V) Global Assessment of Functioning.


2003 ◽  
Vol 29 (4) ◽  
pp. 489-524
Author(s):  
Brent Pollitt

Mental illness is a serious problem in the United States. Based on “current epidemiological estimates, at least one in five people has a diagnosable mental disorder during the course of a year.” Fortunately, many of these disorders respond positively to psychotropic medications. While psychiatrists write some of the prescriptions for psychotropic medications, primary care physicians write more of them. State legislatures, seeking to expand patient access to pharmacological treatment, granted physician assistants and nurse practitioners prescriptive authority for psychotropic medications. Over the past decade other groups have gained some form of prescriptive authority. Currently, psychologists comprise the primary group seeking prescriptive authority for psychotropic medications.The American Society for the Advancement of Pharmacotherapy (“ASAP”), a division of the American Psychological Association (“APA”), spearheads the drive for psychologists to gain prescriptive authority. The American Psychological Association offers five main reasons why legislatures should grant psychologists this privilege: 1) psychologists’ education and clinical training better qualify them to diagnose and treat mental illness in comparison with primary care physicians; 2) the Department of Defense Psychopharmacology Demonstration Project (“PDP”) demonstrated non-physician psychologists can prescribe psychotropic medications safely; 3) the recommended post-doctoral training requirements adequately prepare psychologists to prescribe safely psychotropic medications; 4) this privilege will increase availability of mental healthcare services, especially in rural areas; and 5) this privilege will result in an overall reduction in medical expenses, because patients will visit only one healthcare provider instead of two–one for psychotherapy and one for medication.


2019 ◽  
Vol 6 (1) ◽  
Author(s):  
Vincenza Carchiolo ◽  
Marco Grassia ◽  
Alessandro Longheu ◽  
Michele Malgeri ◽  
Giuseppe Mangioni

AbstractMany systems are today modelled as complex networks, since this representation has been proven being an effective approach for understanding and controlling many real-world phenomena. A significant area of interest and research is that of networks robustness, which aims to explore to what extent a network keeps working when failures occur in its structure and how disruptions can be avoided. In this paper, we introduce the idea of exploiting long-range links to improve the robustness of Scale-Free (SF) networks. Several experiments are carried out by attacking the networks before and after the addition of links between the farthest nodes, and the results show that this approach effectively improves the SF network correct functionalities better than other commonly used strategies.


Proceedings ◽  
2021 ◽  
Vol 77 (1) ◽  
pp. 15
Author(s):  
Hernan Mondani ◽  
Amir Rostami ◽  
Tina Askanius ◽  
Jerzy Sarnecki ◽  
Christofer Edling

This presentation summarizes a register-based study on women who have been identified as belonging to three violent extremist milieus in Sweden: violent Islamic, violent far-right, and violent far-left extremism. We studied the women in these milieus along a number of analytical dimensions, ranging from demographic and educational to criminal background and network relationships, and compared them to three reference groups: (i) non-extremist biological sisters to female extremists in the study population; (ii) men in the respective extremist milieus; and (iii) female members of other antagonistic milieus such as organized crime. Our results showed that there are both similarities and differences between groups. In some cases, like age and region of birth, there are commonalities between violent far-right and violent far-left women. Regarding region of birth and migration background, women affiliated to violent far-right and violent far-left extremism are predominantly born in Sweden. Women affiliated to violent Islamic extremism tend to be born in Sweden to a greater extent than men in the same milieu, but to a much lesser degree than women in the violent far-right and violent far-left. When it comes to education, women in the violent Islamic milieu are closer to women in violent far-right extremism. Women in violent far-left extremism perform best at school, with consistently higher grades. The average score of women in violent far-left extremism is identical to that of their sisters, and women in violent far-left extremism perform on average substantially better than men in the same milieu. Women in violent Islamic extremism, in contrast, perform on average similarly to men in violent far-left extremism, and they perform better than their biological sisters. Regarding labor market attachment, violent Islamic extremists have the weakest attachment and the highest dependency upon financial assistance as well as a low employment share (36 percent in 2016), but also a relatively high share of individuals with a high number of unemployment days, suggesting that women in violent Islamic extremism experience higher social exclusion. We find the highest employment share among women in violent far-left extremism, where 89 percent are gainfully employed in 2016 (80 percent for at least three of the last five years) and about a 20 percent unemployment share. Men in violent far-left extremism have an employment share around 10 percent below that of the women in far-left extremism for 2016. The highest fractions of individuals that have not been in contact with the health system due to mental disorders are among violent Islamic extremism, with the women’s fraction at 84 percent, compared to their non-extremist sisters and men in the same milieu that are just above 79 percent. Women in violent far-left extremism have the highest share of in-patient major mental disorders among the extremist milieus (3 percent), higher than men in the same milieu (less than 1 percent) as well as than women and their sisters in the other categories. During the period 2007–2016, 68 percent of individuals in the extremist milieus are covered by the register of suspected individuals. The coverage is substantially higher for men, 72 percent than for women, 43 percent. Compared to their sisters, women in all three milieus are criminally active to a much higher extent. However, women in all three milieus are less criminally active than women in other antagonistic milieus, among whom 67 percent have been suspected at least once. In all three milieus, the share of men with a criminal record is about twice as large as that of women. As far as the gender aspect is concerned, we know that extremist milieus generally have a conservative view of the role of women in society. In our results, this is reflected in the low rates of crime in women compared to men, and relatively marginal positions in the co-offending networks. The fact that women in violent far-left extremism have stronger positions in their networks than the other women in the study population is expected, given that the ideology of this milieu allows for greater equality. This means that women in violent far-left extremism participate more often than, e.g., women in violent far-right extremism, in political actions where violence is common. This pattern of gender roles and criminal involvement also holds concerning women in violent Islamic extremism. This milieu has a more traditional view of the role of women than views among even violent far-right extremists. Women in violent Islamic extremism are less involved in crime and, in particular, violent crime.


2017 ◽  
Vol 76 (4) ◽  
pp. 427-436 ◽  
Author(s):  
Wolfgang Marx ◽  
Genevieve Moseley ◽  
Michael Berk ◽  
Felice Jacka

Mental illness, including depression, anxiety and bipolar disorder, accounts for a significant proportion of global disability and poses a substantial social, economic and heath burden. Treatment is presently dominated by pharmacotherapy, such as antidepressants, and psychotherapy, such as cognitive behavioural therapy; however, such treatments avert less than half of the disease burden, suggesting that additional strategies are needed to prevent and treat mental disorders. There are now consistent mechanistic, observational and interventional data to suggest diet quality may be a modifiable risk factor for mental illness. This review provides an overview of the nutritional psychiatry field. It includes a discussion of the neurobiological mechanisms likely modulated by diet, the use of dietary and nutraceutical interventions in mental disorders, and recommendations for further research. Potential biological pathways related to mental disorders include inflammation, oxidative stress, the gut microbiome, epigenetic modifications and neuroplasticity. Consistent epidemiological evidence, particularly for depression, suggests an association between measures of diet quality and mental health, across multiple populations and age groups; these do not appear to be explained by other demographic, lifestyle factors or reverse causality. Our recently published intervention trial provides preliminary clinical evidence that dietary interventions in clinically diagnosed populations are feasible and can provide significant clinical benefit. Furthermore, nutraceuticals including n-3 fatty acids, folate, S-adenosylmethionine, N-acetyl cysteine and probiotics, among others, are promising avenues for future research. Continued research is now required to investigate the efficacy of intervention studies in large cohorts and within clinically relevant populations, particularly in patients with schizophrenia, bipolar and anxiety disorders.


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