(1/266) Effectiveness of brief intervention on non-dependent alcohol drinkers (EBIAL): a Spanish multi-centre study.
OBJECTIVE: The project was designed to compare the effectiveness of brief intervention (BI) versus simple advice (SA) in the secondary prevention of hazardous alcohol consumption. METHODS: A randomized controlled trial with a 12-month follow-up was conducted. A total of 74 community-based primary care practices (328 physicians) located in 13 Spanish autonomous regions were recruited initially. Out of 546 men screened, only 229 were randomized into BI (n = 104) and SA (n = 125); 44.6% of practices finalized the study. The interventions on the BI group consisted of a 15-minute counselling visit carried out by physicians which included: (i) alcohol quantification, (ii) information on safe limits, (iii) advice, (iv) drinking limits agreement, (v) self-informative booklet with drinking diary record and (vi) unscheduled reinforcement visits. The SA group spent 5 minutes which included (i), (ii) and (iii). RESULTS: There were no significant differences between both groups at baseline on alcohol use, age, socioeconomic status and CAGE score. After the 12-month follow-up there was a significant decrease in frequency of excessive drinkers (67% of BI group reached targeted consumption, versus 44% of SA; P < 0.001) as well as weekly alcohol intake reduction (BI reached 52 versus 32% in SA; P < 0.001). A trend to improve outcome with the number of reinforcement visits was found with BI. The only predictor of success was the initial alcohol consumption level. CONCLUSIONS: Brief intervention is more effective than simple advice to reduce alcohol intake on adult men who attend primary care services in Spain. (+info)
(2/266) Does psychological intervention help chronic skin conditions?
The objective of the study was to assess the impact of psychological/psychiatric assessment in patients with chronic or intractable dermatological conditions. A diagnostic interview was undertaken in order to pin-point any temporal connection between an adverse life-event and the first appearance of the skin disorder. Following this, the dermatologist's assessment of subsequent changes in the skin disorder were noted. The three main dermatological diagnoses were atopic eczema (10), prurigo (10), and psoriasis (nine). Follow-up was for up to 5 years. A favourable response was noted in 40 out of the 64 patients who participated in the study; this was usually evident within a few weeks and maintained thereafter. Remission was achieved in 12, while 28 showed some improvement. We conclude that this liaison between dermatology and psychiatry proved a valuable adjunct to normal dermatological treatment and was followed by improvement in the majority of patients. (+info)
(3/266) Intraoperative therapeutic suggestions in day-case surgery: are there benefits for postoperative outcome?
To determine if improved postoperative recovery in surgical inpatients receiving intraoperative therapeutic suggestions are applicable in an outpatient population, 70 consenting, unpremedicated adults undergoing elective outpatient hernia repair under general anaesthesia were allocated randomly to either a therapeutic tape (TT) or a comparison tape (CT) group. A standardized general anaesthetic technique was used with propofol, fentanyl or alfentanil, isoflurane and nitrous oxide in oxygen. Pain, and nausea and vomiting were assessed after operation at 30, 60 and 90 min and at 2, 6 and 24 h. The presence of other side effects, such as headache and muscular discomfort, in addition to recall of tape contents, were also evaluated after operation. Absorption ability was measured before operation. The groups were similar in patient characteristics, preoperative, surgical and anaesthetic characteristics, and level of absorption. There were no differences in pain ratings or need for analgesics administered at any time after operation. Nausea/vomiting was experienced significantly fewer times by patients in group TT compared with group CT over the first 90 min (group CT 15%, group TT 4%; P < 0.02), but not over the last three assessment times (group CT 10%, group TT 14%; P < 0.25). The therapeutic tape group experienced fewer side effects over the entire postoperative assessment period (P = 0.03), in particular less headaches (P = 0.03) and less muscular discomfort (P < 0.02). Use of intraoperative therapeutic suggestions could present mildly significant postoperative benefits in outpatients. (+info)
(4/266) The treatment of social phobia in general practice. is exposure therapy feasible?
BACKGROUND: Exposure therapy is an effective treatment for generalized social phobia. Most patients with social phobia are treated in primary care, but family doctors are not usually trained to perform exposure therapy. We have conducted a study in primary care of the effect of exposure therapy alone or in combination with sertraline on generalized social phobia. OBJECTIVES: The purpose of this article is to describe the training of GPs and the application of the treatment programme in general practice. METHOD: Forty-five GPs were trained for approximately 30 h in assessing patients with social phobia and conducting exposure therapy. The training programme included scoring of videotaped interviews of five patients on several social phobia scales, and a videotape demonstrating different steps of an exposure therapy was used as a model for role play in group training. RESULTS: All of the GPs completed the training programme. The doctors expressed satisfaction with the programme and also found it useful in the treatment of patients with conditions other than social phobia. There was a significant difference in response between the treatment groups (P = 0.001), and the combination of exposure therapy and sertraline seemed to be particularly beneficial. (+info)
(5/266) Time-limited psychotherapy with adolescents.
Short-term dynamic therapies, characterized by abbreviated lengths (10-40 sessions) and, in many cases, preset termination dates, have become more widespread in the past three decades. Short-term therapies are based on rapid psychodynamic diagnosis, a therapeutic focus, a rapidly formed therapeutic alliance, awareness of termination and separation processes, and the directive stance of the therapist. The emotional storm of adolescence, stemming from both developmental and psychopathological sources, leaves many adolescents in need of psychotherapy. Many adolescents in need of therapy resist long-term attachment and involvement in an ambiguous relationship, which they experience as a threat to their emerging sense of independence and separateness. Short-term dynamic therapy can be the treatment of choice for many adolescents because it minimizes these threats and is more responsive to their developmental needs. The article presents treatment and follow-up of a 17-year-old youth, using James Mann's time-limited psychotherapy method. (+info)
(6/266) Brief report: parents of children undergoing bone marrow transplantation: documenting stress and piloting a psychological intervention program.
OBJECTIVE: To document levels of stress in parents of children undergoing bone marrow transplantation (BMT) over the course of hospitalization and to pilot a psychological intervention program designed to teach parents techniques for managing stress associated with their child's illness and hospitalization. METHODS: Twenty-two mothers of children (ages 2-16) undergoing BMT were followed prospectively from preadmission to three weeks posttransplant. Eleven mothers, randomly assigned to participate in a pilot intervention program, were compared with 11 control mothers receiving standard care preparation of their child's BMT. RESULTS: Repeated measures ANOVAs detected significant changes in stress over time, with most stress reported preadmission. Mothers in the intervention condition reported using more stress management techniques than mothers in the standard care condition, though the majority of analyses revealed no significant differences in stress between groups. CONCLUSIONS: Increased levels of parenting distress may occur pretransplant, suggesting the need for additional psychological intervention at that time. (+info)
(7/266) General practitioner psychological management of common emotional problems (II): A research agenda for the development of evidence-based practice.
The majority of patients with common emotional or psychological problems are treated solely by general practitioners (GPs). Such treatment frequently includes some form of psychological management within the consultation, whether limited to listening and discussion or involving more specific techniques. This paper sets out a research agenda for the development of effective approaches to GP psychological management. Evidence is reviewed on three core components of all psychological treatments: establishing a positive therapeutic relationship, developing a shared understanding of the problem, and promoting change in behaviour, thoughts or emotions. The application of these components in GP psychological management is outlined and methodological issues in the development and evaluation of GP management approaches are discussed. Since the number of patients with emotional problems seen by each GP is so large, the population effects of even small improvements in psychological management would be sizeable. (+info)
(8/266) Predictors of outcome in a primary care depression trial.
OBJECTIVE: Previous treatment trials have found that approximately one third of depressed patients have persistent symptoms. We examined whether depression severity, comorbid psychiatric illness, and personality factors might play a role in this lack of response. DESIGN: Randomized trial of a stepped collaborative care intervention versus usual care. SETTING: HMO in Seattle, Wash. PATIENTS: Patients with major depression were stratified into severe (N = 149) and mild to moderate depression (N = 79) groups prior to randomization. INTERVENTIONS: A multifaceted intervention targeting patient, physician, and process of care, using collaborative management by a psychiatrist and primary care physician. MEASUREMENTS AND MAIN RESULTS: Patients with more severe depression had a higher risk for panic disorder (odds ratio [OR], 5.8), loneliness (OR, 2.6), and childhood emotional abuse (OR, 2.1). Among those with less severe depression, intervention patients showed significantly improved depression outcomes over time compared with those in usual care (z = -3.06, P<.002); however, this difference was not present in the more severely depressed groups (z = 0.61, NS). Although the group with severe depression showed differences between the intervention and control groups from baseline to 3 months that were similar to the group with less severe depression (during the acute phase of the intervention), these differences disappeared by 6 months. CONCLUSIONS: Initial depression severity, comorbid panic disorder, and other psychosocial vulnerabilities were associated with a decreased response to the collaborative care intervention. Although the intervention was appropriate for patients with moderate depression, individuals with higher levels of depression may require a longer continuation phase of therapy in order to achieve optimal depression outcomes. (+info)