The content and organization of mental health care have been heavily influenced by the view that mental difficulties come as diagnosable disorders that can be treated by specialist practitioners who ...apply evidence‐based practice (EBP) guidelines of symptom reduction at the group level. However, the EBP symptom‐reduction model is under pressure, as it may be disconnected from what patients need, ignores evidence of the trans‐syndromal nature of mental difficulties, overestimates the contribution of the technical aspects of treatment compared to the relational and ritual components of care, and underestimates the lack of EBP group‐to‐individual generalizability. A growing body of knowledge indicates that mental illnesses are seldom “cured” and are better framed as vulnerabilities. Important gains in well‐being can be achieved when individuals learn to live with mental vulnerabilities through a slow process of strengthening resilience in the social and existential domains. In this paper, we examine what a mental health service would look like if the above factors were taken into account. The mental health service of the 21st century may be best conceived of as a small‐scale healing community fostering connectedness and strengthening resilience in learning to live with mental vulnerability, complemented by a limited number of regional facilities. Peer support, organized at the level of a recovery college, may form the backbone of the community. Treatments should be aimed at trans‐syndromal symptom reduction, tailored to serve the higher‐order process of existential recovery and social participation, and applied by professionals who have been trained to collaborate, embrace idiography and maximize effects mediated by therapeutic relationship and the healing effects of ritualized care interactions. Finally, integration with a public mental health system of e‐communities providing information, peer and citizen support and a range of user‐rated self‐management tools may help bridge the gap between the high prevalence of common mental disorder and the relatively low capacity of any mental health service.
It is not yet clear what mental disorders are and what are the causal pathways that lead to them. That makes it difficult to decide what the targets and outcomes of psychotherapies should be. In this ...paper, the main types of targets and outcomes of psychotherapies are described, and a brief overview is provided of some of the main results of research on these types. These include symptom reduction, personal targets and outcomes from the patient's perspective, improvement of quality of life, intermediate outcomes depending on the theoretical framework of the therapist, negative outcomes to be avoided, and economic outcomes. In line with the dominance of the DSM and ICD systems for diagnoses, most research has been focused on symptom reduction. This considerable body of research, with hundreds of randomized trials, has shown that for most mental disorders effective psychotherapies are available. There is also research showing that psychotherapies can result in improvement of quality of life in most mental disorders. However, relatively little research is available on patient‐defined outcomes, intermediate outcomes, negative outcomes and economic outcomes. Patients, relatives, therapists, employers, health care providers and society at large each have their own perspectives on targets and outcomes of psychotherapies. The perspective of patients should have more priority in research, and a standardization of outcome measures across trials is much needed.
Objectives
A small number of studies to date have examined Partial Hospital (PH) that utilize a Dialectical Behavior Therapy (DBT) model. Preliminary findings suggest DBT PH programs can be effective ...in various symptom reduction.
Methods
This study examined clinically relevant outcomes and included a heterogeneous clinical sample over a five‐year period. Specifically, the present study assessed pre–post data to examine changes in symptoms of depression, anxiety, hopelessness, and overall degree of suffering from intake to discharge in a DBT PH.
Results
Findings showed symptom reduction from intake to discharge for depression, anxiety, hopelessness, and suffering for all 5 years. This DBT PH program was successful at reducing various symptoms in a sample of psychiatric patients.
Conclusion
Clinicians might consider the advantages of placing patients in PH programs versus an inpatient stay or consider utilizing DBT‐informed PH programs after an inpatient hospitalization as a form of step‐down care.
Many patients with cancer live in rural areas and research is lacking on the efficacy of palliative care programs in rural community settings. This pilot study was conducted in a primarily rural ...setting where healthcare professionals delivered palliative care to 52 mostly lower income patients with a variety of cancers. They were assessed for physical, financial, psychosocial and overall symptom intensity at baseline and at three consequent assessments. This pilot study demonstrated the potential efficacy of an outpatient palliative care program in a mostly rural setting in the reduction of physical, psychosocial, and overall symptom intensity in patients with cancer.
Background: Music-based interventions are currently being researched for their effectiveness in schizophrenia. Very few studies have been done in the acute phase. Further, there is a dearth of ...published Indian research in this context. Methods: A prospective, randomized, controlled, single-blind study was done in a tertiary psychiatric hospital in South India from October-2015 to March-2016. Immediately after admission, consenting adult patients with schizophrenia were randomly assigned to two groups. Over four weeks, Group-A(N=51) received 20 sessions of music-listening as an add-on to standard care, and Group-B(N=53) received standard care alone. Reduction in Positive and Negative Syndrome Scale (PANSS) scores and the drug dosage requirements for both groups were compared. Statistical analysis was done using two-way repeated-measures ANOVA for PANSS score reduction and Mann-Whitney U for drug dosage comparison. Results: We observed a greater decrease in PANSS scores in Group-A than Group B, but this difference did not reach significance (p>0.05 for all three subscales and total score). Group-A required lesser risperidone-equivalent doses than Group-B, but this was not significant (p=0.27). However, Group-A required significantly lesser diazepam equivalent (p=0.003) and trihexyphenidyl (p=0.007) doses than Group-B. Conclusions: The above findings suggest a possible additional benefit of adding music listening to standard care for the acute phase management of schizophrenia and reducing drug dosage requirements. Music-based interventions for schizophrenia warrant further research, especially in the Indian context and wider application in clinical practice.
Abstract
Objective
Patients and other stakeholders generally report high satisfaction with neuropsychological evaluations (NPEs), but no research has examined effects of cognitive, emotional, and ...other factors that often prompt evaluations. A prospective, quasi-experimental study was conducted to examine self-reported cognitive and psychiatric symptoms, self-efficacy, motivation, and satisfaction following a NPE.
Method
Participants from a neuropsychology clinic who were diagnosed with AD/HD and/or a DSM-IV mood disorder based on a NPE were included, and excluded if diagnosed with dementia or failure on performance validity tests.
Results
To examine whether a NPE with an interventional feedback session was associated with outcomes, changes from baseline to post-feedback session were examined with repeated-measures analysis of variance. Pearson correlations determined whether changes in hypothesized mechanisms (i.e., self-efficacy, goal importance and confidence ratings, and use of cognitive strategies) were related to changes in cognitive or psychiatric symptom severity. At follow-up, participants reported reductions in psychiatric (change in Brief Symptom Inventory depression: M = -2.8, SD = 4.4, range = −11 to 8, ${\eta}_p^2$=.30; anxiety: M = 3.2, SD = 6.6, range = −21 to 10, ${\eta}_p^2$ = .20) and cognitive symptoms (change in Multiple Ability Self-Report Questionnaire attention: M = −0.3, SD = 0.5, range = −1.6 to 0.5, ${\eta}_p^2$ = .31; verbal memory: M = −0.3, SD = 0.5, range = −1.1 to 0.5, ${\eta}_p^2$ = .24; language: M = −0.4, SD = 0.4, range = −1.3 to 0.4, ${\eta}_p^2$ = .48), and improved cognition (change in Meta-Memory Questionnaire ability: M = 4.4,SD = 6.2, range = −10 to 16, ${\eta}_p^2$ = .35; contentment: M = 4.3, SD = 4.5, range = −7 to 14, ${\eta}_p^2$ = .49). Participants reported increased self-efficacy for general and evaluation-specific goals. Increased goal-specific self-efficacy was associated with large reductions in psychiatric symptoms.
Conclusions
Participants reported high levels of satisfaction with the NPE. Results support the clinical utility of NPE and feedback, and underscore the importance of individualized goal setting as part of the evaluation process.
Chemotherapy-induced peripheral neuropathy (CIPN) is a prevalent and clinically relevant side effect of chemotherapy. The symptoms diminish patients’ quality of life and represent a decisive limiting ...factor for medical therapy. To date, effective treatment options are lacking. Specific exercise interventions have proven promising to target relevant symptoms. We conducted a prospective, four-armed, randomized, controlled trial, to evaluate the effects of sensorimotor training (SMT) and whole-body vibration training (WBV) on patients with CIPN. Participants (
N
= 40) were randomized to either one of two intervention groups (SMT
N
= 10 or WBV
N
= 10) or oncological control group (
N
= 10) and matched by gender and age with a healthy control (
N
= 10). The intervention groups exercised twice a week for 6 weeks. Primary endpoint was the reduction of CIPN-related symptoms (improve peripheral deep sensitivity, Achilles tendon reflex (ASR) and patellar tendon reflex (PSR), light-touch perception, sense of position, and lower leg strength). Secondary endpoints were nerve conduction velocity and amplitude, balance control, quality of life, and CIPN-related pain. Patients exercising improved sensory and associated motor symptoms. Significant intergroup differences were found for the tendon reflexes (ASR
P
= .017 and PSR
P
= .020), peripheral deep sensitivity (
P
= .010), and pain (
P
= .043). Furthermore, tendencies were found regarding the subjective improvement of symptoms (
P
= .075) and two subscales of the EORTC-QLQ-C30 questionnaire: pain (
P
= .054) and dyspnea (
P
= .054). The results for the SMT group were superior regarding the tendon reflexes, and a tendency regarding the subjective report of symptoms, while WBV was superior regarding pain. SMT and WBV behold a large potential to reduce CIPN-related symptoms and can be considered feasible and safe for patients with CIPN (compliance 97.5%, no adverse events).
Registration: DRKS00013027
Guided Internet-delivered therapy has shown to be an effective treatment format for anxiety disorders. However, not all patients experience improvement, and although predictors of treatment outcome ...have been identified, few are consistent over time and across studies. The current study aimed to examine whether treatment self-efficacy (self-efficacy regarding the mastery of obstacles during treatment) in guided Internet-delivered therapy for anxiety disorders in adults could be a predictor of lower dropout rates and greater symptom reduction.
The analyzed data comes from an open effectiveness study including 575 patients receiving guided Internet-delivered therapy for panic disorder or social anxiety disorder. Treatment self-efficacy was measured at pre-treatment. Symptom reduction was measured at 10 measurement points, including a 6-month follow-up. A mixed linear model was applied in the analysis.
The results showed that high treatment self-efficacy was a predictor of both lower dropout rates and greater symptom reduction. Significant interaction effects between time and treatment self-efficacy were found for several of the nine modules that constitutes the treatment program, suggesting that treatment self-efficacy could be a moderator of symptom reduction. Three of nine modules in the panic disorder treatment and six of nine in the social anxiety disorder treatment showed significant interaction effects.
The results suggest that measuring treatment self-efficacy may be a valuable tool to identify patients at risk of dropping out, and that treatment self-efficacy could be a predictor and moderator of symptom reduction in guided Internet-delivered therapy. The implications of the results are discussed.
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