The influence of therapy alliance and treatment motivation in patients with Cluster B personality disorders on incidents in forensic hospitals

Purpose Nonspecific factors such as therapy alliance and treatment motivation have been shown to be predictive of therapy outcome. However, research investigating these factors among patients with personality disorders, or studies in the context of mandated treatment showed mixed results. A new theory furthermore speculates there may be differences between early formed therapeutic alliance (trait-like) versus alliance formed on the longer term (state-like). This paper aims to investigate the effects of therapy alliance and treatment motivation in 103 Dutch male forensic psychiatric patients with Cluster B personality disorders. Design/methodology/approach The authors used incidents as a measure of treatment outcome. They studied the effect of nonspecific factors on incidents in two phases, namely, 0 – 18 months and 18 – 36 months, along with known predictors of incidents (age, Historical items of the HCR-20 and psychopathy) as covariates. Findings Regression models predicting incidents in the first 18 months of treatment were nonsignificant. Incidents in the second 18 months were significantly predicted by models including alliance and motivation measured at the start of treatment, but not measures at 18 months and covariates. Predictors, except for age, were all nonsignificant. Practical implications These findings lend tentative support for the trait-like vs state-like theory of change through nonspecific factors. However, it may also be that other factors are more important in predicting therapy outcome in forensic psychiatric patients with Cluster B personality disorders. Originality/value The current study represents the first effort to study the effects of non-specific factors on therapeutic discourse in hospitalized offenders with Cluster B personality disorders.

NONSPECIFIC FACTORS OF ORGANISM RESISTANCE IN PATIENTS WITH ERYSIPELAS

Summary. Aim. The article is aimed to assess the nonspecific factors of the body’s resistance in patients with erysipelas and in the development of sepsis in these patients. Materials and methods. 114 case histories of patients who underwent inpatient treatment in the center of purulent-septic surgery in the Non-profit municipal enterprise “City Hospital № 3” in Zaporizhzhia for the period 2019-2020 were analyzed. According to the forms of the disease, the patients were distributed as follows: erythematous — 24 (21.0 %), bullous — 28 (24.6 %), phlegmonous — 48 (42.1 %), necrotic — 14 (12.3 %). Recurrent cases of the disease were noted in 21 patients. From them: with erythematous form — 4 (16.7 %), bullous — 5 (17.9 %), phlegmonous — 9 (18.7 %), necrotic — 3 (21.4 %). Among 10 patients, the disease was complicated by sepsis. 6 patients died, mortality was 60 %. Results and their discussion. Depending on the detected disorders, the patients were divided into three groups: with uniformly activated immune status; with a suppressive type of immune response; with a mixed type of immune status, where with a normal or suppressive cellular link of immunity, activation of some indicators of the humoral link against the background of a normal or reduced level of complement is determined, which indicates the sensitization of T-cell populations with an antigen and the development of autoimmune processes. Conclusions. An increase in complement levels is an indicator of active antigen-antibody binding reactions in patients with erysipelas. Weak NBT-reaction in patients with sepsis indicates depletion of the enzymological activity of neutrophilic leukocytes and, to some extent, can serve as a predictor of a lethal outcome. An increase in the rates of phagocytosis is a prognostically favorable sign indicating the effective removal of the antigenic material of immune complexes from the patient’s body.

FEATURES OF DEVELOPMENT OF GENERALIZED PERIODONTITIS IN PERSONS WITH SECRETORY IMMUNOGLOBULIN A DEFICIENCY AND ITS TREATMENT (LITERATURE REVIEW)

The aim: To present data on the possibility of occurrence and active progression of generalized periodontitis in persons with secretory immunoglobulin A deficiency and possible methods of its correction. Мaterials and methods: Analytical elaboration of scientific and medical literature based on the immunological aspect of generalized periodontitis. Conclusions: The deficiency of secretory immunoglobulin A may occur in cases of primary or secondary insufficiency of the immune system. Selective IgA deficiency is an example of primary insufficiency of the immune system. Secondary immunodeficiency disorders is a clinical and immunological syndrome that develops against the background of a previously normally functioning immune system, characterized by a steady decrease in quantitative or functional indicators of specific or(and) nonspecific factors of immunoresistance. Insufficient awareness of dentists about certain aspects of the etiology and pathogenesis of generalized periodontitis leads to deterioration of treatment results.

Factors affecting the composition of the gut microbiota, and its modulation

Gut microbiota have important functions in the body, and imbalances in the composition and diversity of those microbiota can cause several diseases. The host fosters favorable microbiota by releasing specific factors, such as microRNAs, and nonspecific factors, such as antimicrobial peptides, mucus and immunoglobulin A that encourage the growth of specific types of bacteria and inhibit the growth of others. Diet, antibiotics, and age can change gut microbiota, and many studies have shown the relationship between disorders of the microbiota and several diseases and reported some ways to modulate that balance. In this review, we highlight how the host shapes its gut microbiota via specific and nonspecific factors, how environmental and nutritional factors affect it, and how to modulate it using prebiotics, probiotics, and fecal microbiota transplantation.

The Hyperfocusing Hypothesis: A New Account of Cognitive Dysfunction in Schizophrenia

Impairments in basic cognitive processes such as attention and working memory are commonly observed in people with schizophrenia and are predictive of long-term outcome. In this review, we describe a new theory—the hyperfocusing hypothesis—which provides a unified account of many aspects of impaired cognition in schizophrenia. This hypothesis proposes that schizophrenia involves an abnormally narrow but intense focusing of processing resources. This hyperfocusing impairs the ability of people with schizophrenia to distribute attention among multiple locations, decreases the number of representations that can simultaneously be maintained in working memory, and causes attention to be abnormally captured by irrelevant inputs that share features with active representations. Evidence supporting the hyperfocusing hypothesis comes from a variety of laboratory tasks and from both behavioral and electrophysiological measures of processing. In many of these tasks, people with schizophrenia exhibit supranormal effects of task manipulations, which cannot be explained by a generalized cognitive deficit or by nonspecific factors such as reduced motivation or poor task comprehension. In addition, the degree of hyperfocusing in these tasks is often correlated with the degree of impairment in measures of broad cognitive function, which are known to be related to long-term outcome. Thus, the mechanisms underlying hyperfocusing may be a good target for new treatments targeting cognitive deficits in schizophrenia.

The Case of "Daniel": Flexibly Delivering an Inherently Challenging Treatment in the Face of a Complex Presentation

In this article, I respond to commentaries by Martin Franklin (2019) and by Liza Pincus and Andrea Quinn (2019) about my case study of "Daniel" (Tice, 2019), a 14-year-old young man presenting to therapy with Obsessive Compulsive Disorder (OCD) and Generalized Anxiety Disorder (GAD). I treated Daniel with a manual-based, 25-session treatment centered around the cognitive-behavioral approach of Exposure and Response Prevention (E/RP). A major theme running through my case study and the two commentaries is the need for flexibility in adapting the manual to be responsive to a variety of factors associated with Daniel’s disorder, such as his personality, interests, life situation, attitude towards his symptoms, and his way of relating to the therapist. In the context of the commentaries, I review a variety of the specific ways in which I learned to be flexible. Some of these included (a) focusing on nonspecific factors in developing a strong therapeutic alliance and rapport; (b) paying particular attention to how I communicated relevant psychoeducational concepts to Daniel, particularly by the use of metaphors, in preparing him for the E/RP procedures and in encouraging his participation; and (c) focusing on the process of making decisions at important clinical choice points.

Why and How Should We Integrate Biomarkers into Complex Trials? A Discussion on Paradigms and Clinical Research Strategies

Background: Research in complementary and alternative medicine (CAM) encounters a variety of challenges, such as potentially synergistic, multimodal, and complex interventions which are often dependent on the relationship between practitioner and patient, on specific settings, and on patients’ individual preferences, expectations, beliefs, and motivations. Moreover, patients seeking CAM care often suffer from chronic disease conditions, and multiple symptoms and/or pathologies. On the other hand, CAM interventions are often challenged as being solely dependent on subjective and nonspecific factors without biologically based mechanisms of action. If we agree that biomarkers as outcomes are important for the understanding of CAM interventions, a hypothesis- and strategy-driven process for the selection of the most appropriate biomarkers is needed. Methods: This paper presents the results of an expert panel on how to integrate biomarkers in whole system research of an interdisciplinary workshop on research methodology in CAM held in November 2012. Results: The following main CAM research challenges were identified: (a) finding appropriate biomarkers, which are able to picture the complex pathophysiological pathways and likewise complex interventions under study; (b) integrating these biomarkers into clinical trials in CAM; and (c) identifying the biomarkers specific to the particular CAM intervention being applied. Conclusion: The paper provides a disease/condition/symptom- and intervention-driven strategy regarding how to identify the outcomes of interest and possible related biomarkers. The research approach presented here allows the selected biomarkers to be grounded in conventional physiology/pathophysiology as well as complementary and alternative concepts, including traditional systems of medicine. The goal is to provide researchers in the field with a framework on how to integrate biomarkers into complex trials.