Background Insomnia is a very common condition in various populations. Non‐pharmacological interventions might offer (safe) alternatives for hypnotics.
Aim To evaluate the evidence for efficacy ...from systematic reviews about non‐pharmacological interventions to improve sleep quality in insomnia by a systematic review of systematic reviews and meta‐analyses.
Search strategy Search strategies were conducted in the Database of s of Reviews of Effects (2002–July 2008), The Cochrane Database of Systematic Reviews (2000–July 2008) and PubMed (1950–July 2008). Sleep quality was the outcome measure of interest.
Selection criteria Systematic reviews about the efficacy of one or more non‐pharmacological interventions for insomnia, concerning both adult and elderly populations, were included. Reviews that included studies performed among populations suffering with severe neurological or cognitive impairments or with addictive disorders were excluded.
Data analysis Relevant data were extracted. The quality of the reviews found was appraised by using the Overview Quality Assessment Questionnaire. The evidence was appraised and divided into six classes.
Results and conclusions Sixteen reviews about 17 interventions were included. Six reviews were of adequate methodological quality. Of these, only one provided an effect size: a moderate effect was found for music‐assisted relaxation. Weak evidence indicating a large effect was found for multicomponent cognitive behavioural therapy, progressive muscle relaxation, stimulus control and ‘behavioural only’. Weak evidence indicating a moderate effect was found for paradoxical intention. Finally, weak evidence indicating a moderate to large effect was found for relaxation training. Because of the lack of sufficient methodological quality and the lack of calculated effect sizes, most of the included reviews were not suitable for drawing rigorous conclusions about the effect of non‐pharmacological interventions on sleep quality in insomniacs. The non‐pharmacological treatment of insomnia would benefit from renewed reviews based on a rigorous methodological approach.
In this paper, false-negative and false-positive cases of depressive illness are examined, differentiating levels of disagreement between a primary care physician’s diagnosis and a standardized ...research diagnosis. Two stratified random samples of primary care patients in Seattle, USA (
N = 373) and Groningen, The Netherlands (
N = 340) were examined with the Composite International Diagnostic Interview-Primary Health Care Version (CIDI-PHC). Physician’s severity ratings and diagnosis of psychological disorder were obtained. Three levels of disagreement between physician and CIDI diagnosis were distinguished: 1) complete disagreement about the presence of psychiatric symptoms (true false-negative and true false-positive patients); 2) disagreement over severity of recognized psychological illness (underestimated or overestimated); and 3) disagreement over the specific psychiatric diagnosis among those given a diagnosis (misdiagnosed or given another CIDI diagnosis). All three levels of disagreement were common. Only 27% of the false-negative cases were due to complete disagreement (true false-negatives), and 55% of the false-positives were due to complete disagreement (true false-positives). The true false-negative patients were younger, more often employed, rated their own health more favorably, visited their doctor for a somatic complaint and made fewer visits than the underestimated, misdiagnosed, and concordant positive patients. Complete disagreement in depressive diagnoses between the primary care physician and research interview is not as frequent as indicated by an undifferentiated false-negative/false-positive analysis. Differentiating levels of disagreement does more justice to diagnostic practice in primary care and provides guidance on how to improve the diagnostic accuracy of primary care physicians.
Objective: The effectiveness of two versions of stepped care with either brief therapy (BT) or cognitive behavioural therapy (CBT) as a first step is studied in comparison with the traditional ...matched care approach (CAU) for patients with mood and anxiety disorders.
Method: A randomized trial was performed in routine mental health care in 12 settings, including 702 patients. Patients were interviewed once in 3 months for 18–24 months (response rate 69%).
Results: Overall, patients’ health improved significantly over time: 51% had achieved recovery from the DSM‐IV disorder(s) after 1 year and 66% at the end of the study. Respectively, 50% and 60% had ‘normal’ SCL90 and SF36 scores. Cognitive behavioural therapy and BT patients achieved recovery more often than CAU patients (ORs between 1.26 and 1.48), although these results were not statistically significant.
Conclusion: Stepped care, with BT or CBT as a first step, is at least as effective as matched care.
Background: Sickness absence often occurs in patients with emotional distress or minor mental disorders. In several European countries, these patients are over-represented among those receiving ...illness benefits, and interventions are needed. The aim of this study was to evaluate the cost-effectiveness of an intervention conducted by social workers, designed to reduce sick leave duration in patients absent from work owing to emotional distress or minor mental disorders. Methods: In this Randomized Controlled Trial, patients were recruited by GPs. The intervention group (N = 98) received an activating, structured treatment by social workers, the control group (N = 96) received routine GP care. Sick leave duration, clinical symptoms, and medical consumption (consumption of medical staffs' time as well as consumption of drugs) were measured at baseline and 3, 6, and 18 months later. Results: Neither for sick leave duration nor for clinical improvement over time were significant differences found between the groups. Also the associated costs were not significantly lower in the intervention group. Conclusions: Compared with usual GP care, the activating social work intervention was not superior in reducing sick leave duration, improving clinical symptoms, and decreasing medical consumption. It was also not cost-effective compared with GP routine care in the treatment of minor mental disorders. Therefore, further implementation of the intervention is not justified. Potentially, programmes aimed at reducing sick leave duration in patients with minor mental disorders carried out closer to the workplace (e.g. by occupational physicians) are more successful than programmes in primary care.
Our study was motivated mainly by the results from nemesis-2 which showed that four out of ten patients in ambulantory mental health care had not had any mental disorder in the previous 12 months. A ...dsm-iv classification of the symptoms of patients is required for receiving insured mental health care.
To find out whether patients who attended a mental health generalistic or specialised clinic had a dsm-classified mental disorder and to assess the severity of these patients' symptoms. We have given specific attention to the characteristics of patients with subclinical symptoms who turned up at the mental health care clinics.
dsm-iv disorders of patients in mental health care were studied by means of the mini 5.0.0 (n = 3072). The oq-45 was used to determine the severity of symptoms in both generalistic (n = 2255) and specialised mental health care (n = 5009). Logistical regression was used to determine the differences between the characteristics of patients who had clinical scores and those of patients who had subclinical scores. For this purpose we also used anonymised data from the personal health records.
During the intake procedure at specialised mental health care clinics only 14.3 % of patients failed to meet the diagnostic criteria of a dsm-iv disorder. Also, 56.5 % of patients seen by a mental health generalist and 70,9 % of patients seen by a mental health specialist had high or very high symptomatic distress, according the oq-45. The proportion of patients with a dsm-iv disorder varied from 52.9 % for patients with subclinical oq-45 scores to 94.8 % for patients with very high oq-45 scores. Predictors of patients with subclinical oq-45 scores were similar in generalistic and specialised mental health care.
Only a small number of patients in specialised care did not have an axis 1 dsm-iv diagnosis. Most patients in generalistic and specialised mental health care reported severe symptomatic distress. Symptoms mentioned by patients with subclinical oq-scores at the start of treatment were mainly stress-related.
OBJECTIVES: To explore whether movement quality has influence on heart rate (HR) frequency during the dance-specific aerobic fitness test (DAFT). METHODS: Thirteen contemporary university dance ...students (age 19 ± 1.46 yrs) underwent two trials performing the DAFT while wearing
a Polar HR monitor (Kempele, Finland). During the first trial, dancers were asked to perform the movements as if they were performing on stage, whereas during the second trial, standardized verbal instructions were given to reduce the quality of movement (e.g., no need to perform technically
correct pliés). The variables measured at each trial were HR for all five stages of the DAFT and HR recovery (1 and 2 min after finishing the DAFT), movement quality (MQ) score, and rate of perceived exertion score (RPE). RESULTS: There were significant differences in HR between Trial
1 and Trial 2. For all stages and the resting period, HR was lower during Trial 2 (p<0.001). Also, the RPE score was significantly lower and the MQ score was significantly higher, indicating a poorer performance, during Trial 2 (both p<0.001). CONCLUSION: The results suggest that DAFT
performance with lower movement quality elicits lower HR frequency and RPE during the DAFT. We recommend that specific instructions be given to participants about executing the movement sequence during the DAFT before testing commences. Also, movement quality must be taken into account when
interpreting HR results from the DAFT in order to distinguish if a dancer's low HR results from good aerobic fitness or from poor performance of the movement sequence.
Epidemiological surveys demonstrate that unipolar depression is more common in females than in males. Gender-specific cultural and social factors may contribute to the female preponderance. This ...study explores this possibility in a cross-cultural sample of general-practice patients systematically recruited in the WHO study “Psychological Problems in Primary Care” conducted in 14 countries with identical sampling and assessment strategies. Although absolute prevalence rates are broadly varying between centers proposing that the gender ratio is nearly constant with 1:2. The cultural context does not contribute substantially to the female preponderance. This study lends some support to previous observations that the magnitude of female preponderance is associated with the number of symptoms associated with depression requested for caseness and inversely related to the degree of social impairment. Matching social role variables (marital status, children, occupational status) between females and males reduces the female excess by about 50% across all centers. Therefore, we conclude that social factors are inducing part of the preponderance of females among depressed cases.
Tijdschrift voor psychiatrie de Jong, K; Tiemens, B; Verbraak E A, M J P M
Tijdschrift voor psychiatrie,
01/2017, Letnik:
59, Številka:
4
Journal Article
The association between level of personality organization as assessed by theory-driven profile interpretation of the MMPI (Hathaway & McKinley, 1943) Dutch Short Form and treatment outcome was ...investigated in a naturalistic follow-up study among 121 psychotherapy inpatients who had been treated for their severe personality pathology. Treatment outcome was measured with the Brief Symptom Inventory (De Beurs & Zitman, 2006). Personality organization was associated with severity of psychopathology at baseline, the end of treatment, and 36 months after baseline. At 36 months after baseline, all patients except those with the high-level borderline organization profile and the psychotic borderline profile maintained their improvement. Contrary to expectations, (a) personality organization did not differentiate between patients with successful and unsuccessful out-comes, and (b) patients with a neurotic personality organization did not respond better than those with a borderline personality organization. Because of the small N, conclusions are tentative.
Minor mental disorders are common among patients who visit their general practitioner. In the Netherlands, they are associated with high costs due to absenteeism, disability benefits and medical ...consumption (consumption of drugs as well as expenditure of medical staff’s time). In the Netherlands, a protocol was developed for the treatment of minor mental disorders, based on the principles of brief cognitive behaviour therapy. The cost-effectiveness of this protocol was tested in a group of patients whose minor mental disorders had lead to sickness absence. The protocol was completed by Dutch social workers, one of whose core tasks normally is to provide psychosocial care. The main aims of the protocol are for the patient to regain functionality and to prevent long-term disability. The protocol emphasizes patients’ own responsibility and active role in the recovery process, includes homework assignments and stresses the importance of early work resumption. This article focuses on a discussion of the feasibility of this treatment for minor mental disorders. The evidence for or against the protocol’s cost-effectiveness will be discussed in future papers. The results show that patients, social workers and general practitioners were motivated to participate and that the protocol was well received by all three groups. If the treatment also proves to be cost-effective, it would appear to be a promising intervention for a frequently encountered problem in primary care.
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