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Psychological Treatments (psychological + treatment)

Distribution by Scientific Domains

Medical Sciences	68%
Psychology	26%
2 Other Domains	6%

Distribution within Medical Sciences

Psychiatry	45%
Nursing General	5%

Selected Abstracts

Psychological Treatment and Medication for the Mood and Anxiety Disorders: Moderators, Mediators, and Domains of Outcome

CLINICAL PSYCHOLOGY: SCIENCE AND PRACTICE, Issue 1 2005
David J. MiklowitzArticle first published online: 11 MAY 200
Studies that combine pharmacotherapy with psychological treatment for the mood and anxiety disorders must consider the role of moderators (pretreatment variables that specify the conditions under which treatments are effective) and mediators (change mechanisms in the causal pathways between treatments and outcomes) in explaining the impact of experimental treatments. This article gives examples of the kinds of moderators and mediators,both psychosocial and biological,that are important to examine in combination treatment studies. It conceptualizes outcome as involving multiple domains, including mood and anxiety symptoms, life functioning, and illness costs. Research should also examine the appropriate sequencing of pharmacological and psycho-social interventions and how this sequencing may vary from disorder to disorder. [source]

Effectiveness of current treatment approaches for benzodiazepine discontinuation: a meta-analysis

ADDICTION, Issue 1 2009
Jannette M. Parr
ABSTRACT Aims To assess the effectiveness of current treatment approaches to assist benzodiazepine discontinuation. Methods A systematic review of approaches to benzodiazepine discontinuation in general practice and out-patient settings was undertaken. Routine care was compared with three treatment approaches: brief interventions, gradual dose reduction (GDR) and psychological interventions. GDR was compared with GDR plus psychological interventions or substitutive pharmacotherapies. Results Inclusion criteria were met by 24 studies, and a further eight were identified by future search. GDR [odds ratio (OR) = 5.96, confidence interval (CI) = 2.08,17.11] and brief interventions (OR = 4.37, CI = 2.28,8.40) provided superior cessation rates at post-treatment to routine care. Psychological treatment plus GDR were superior to both routine care (OR = 3.38, CI = 1.86,6.12) and GDR alone (OR = 1.82, CI = 1.25,2.67). However, substitutive pharmacotherapies did not add to the impact of GDR (OR = 1.30, CI = 0.97,1.73), and abrupt substitution of benzodiazepines by other pharmacotherapy was less effective than GDR alone (OR = 0.30, CI = 0.14,0.64). Few studies on any technique had significantly greater benzodiazepine discontinuation than controls at follow-up. Conclusions Providing an intervention is more effective than routine care. Psychological interventions may improve discontinuation above GDR alone. While some substitutive pharmacotherapies may have promise, current evidence is insufficient to support their use. [source]

Psychological treatment may reduce the need for healthcare in patients with Crohn's disease,

INFLAMMATORY BOWEL DISEASES, Issue 6 2007
Hans-Christian Deter MD
Abstract Background: Few published studies examine the influence of psychological treatment on health care utilization in Crohn's disease. Methods: The present substudy of a prospective, randomized, multicenter trial conducted in 69 of 488 consecutive Crohn's disease (CD) patients was designed to investigate the way in which healthcare utilization is influenced by psychotherapy and relaxation in addition to standardized glucocorticoid therapy. Before and after a 1-year period of standardized somatic treatment the psychotherapy and control groups were compared with regard to hospital and sick-leave days. Predictors of healthcare utilization were analyzed. Results: The comparison between groups before and after psychological treatment showed a significantly higher decrease of mean hospital days (P < 0.03) and sick-leave days in the treatment group compared with the controls. When a covariate analysis was applied to compare the data at randomization, the difference in hospital days remained statistically a trend (P < 0.1). Multivariate regression analysis detected a significant gender and depression effect for hospital days (cor r2 = 0.114) and a significant gender and age effect for sick-leave days (cor r2 = 0.112). Conclusion: A significant drop in healthcare utilization after psychological treatment demonstrates a clear benefit of this additional therapy. This is important, since the study failed to demonstrate significant changes in the psychosocial status or somatic course of study patients. Clinical and psychological factors influencing these outcomes are discussed. (Inflamm Bowel Dis 2007) [source]

The effectiveness of psychological treatments for treatment-resistant depression: a systematic review

ACTA PSYCHIATRICA SCANDINAVICA, Issue 5 2005
S. McPherson
Objective:, A systematic review of all studies (controlled and uncontrolled) to evaluate psychological interventions with treatment-resistant depression. Method:, A systematic search to identify studies evaluating a psychological intervention with adults with a diagnosis of major depressive disorder who had not responded to at least one course of antidepressant medication. Results:, Twelve studies met inclusion criteria, of which four were controlled and eight uncontrolled. Treatment effect sizes were computable for four studies and ranged from 1.23 to 3.10 with a number of better quality studies demonstrating some improvements in patients following a psychological intervention. Conclusion:, Psychological treatments for depression are commonly delivered and often recommended following the failure of medication. The paucity of evidence for their effectiveness in these situations is a significant problem. There is a need for studies with a strong controlled design investigating the effectiveness of psychological treatments for patients with treatment-resistant depression. [source]

Psychological treatments for functional non-epileptic attacks: a systematic review

ACTA NEUROPSYCHIATRICA, Issue 4 2009
Danielle Gaynor
Objective: There is a lack of clarity about the most useful intervention for functional non-epileptic attacks (FNEA). Outcomes for this condition remain often poor, with considerable personal, social and economic impact. In order to guide clinical practice and future research in this area, we have performed a systematic review of the published literature on the psychological treatment of FNEA. Methods: A comprehensive literature search was carried out using key words: non-epileptic seizures; psychogenic seizures; psychogenic non-epileptic seizures; pseudoseizures; funny turns; non-epileptic attack; hysterical seizures; and pseudoepileptic. Studies specifically looking at psychological treatment of FNEA were identified. Studies of patients also having comorbid organic seizure disorders were excluded. Results: 17 studies that met the inclusion criteria were identified. A broad variety of psychological interventions for FNEA has been investigated. Only one randomised controlled trial has been completed to date. Existing evidence appears to suggest that various psychological treatments, including presenting the diagnosis, psychoeducation, behavioural therapies and mixed modality treatments, may be effective. Conclusion: While a range of psychological treatments may be beneficial for this patient group, we do not have clear evidence to suggest which treatment is most efficacious. Specific elements of presenting the diagnosis and psychoeducation may be required in addition to traditional cognitive behavioural therapeutic approaches. Large, methodologically robust studies are urgently required to establish the most effective form of treatment. [source]

Treatment of major depressive disorder in the Finnish general population

DEPRESSION AND ANXIETY, Issue 11 2009
Juha Hämäläinen M.D.M.A.
Abstract Background: Few general population studies of the treatment of major depressive disorder (MDD) have included the whole spectrum of treatments. We estimated the rates of different treatments and the effect of individual and disorder characteristics plus provider type on treatment received. Methods: In the Health 2000 Study, a representative sample (n=6,005) from the adult Finnish population (,30 years) were interviewed (CIDI) in 2000,2001 for the presence of DSM-IV mental disorders during the past 12 months. Logistic regression models were used to examine factors influencing the type of treatment: either pharmacotherapies (antidepressants, anxiolytics, sedatives/hypnotics, antipsychotics) or psychological treatment. Results: Of the individuals with MDD (n=288), currently 24% used antidepressants, 11% anxiolytics, 16% sedatives/hypnotics, 5% antipsychotics, and 17% reported having received psychological treatment. Overall, 31% received antidepressants or psychological treatment or both; 18% received minimally adequate treatment. Of those 33% (n=94) using health care services for mental reasons, 76% received antidepressants or psychological treatment or both; 54% received minimal adequate treatment. In logistic regression models, the use of antidepressants was associated with female sex, being single, severe MDD, perceived disability, and comorbid dysthymic disorder; psychological treatment with being divorced, perceived disability, and comorbid anxiety disorder. Conclusions: Due to the low use of health services for mental reasons, only one-third of subjects with MDD use antidepressants, and less than one-fifth receives psychological treatment. The treatments provided are determined mostly by clinical factors such as severity and comorbidity, in part by sex and marital status, but not education or income. Depression and Anxiety 26:1049,1059, 2009. © 2009 Wiley-Liss, Inc. [source]

Context-Oriented Model Development in Psychotherapy Planning (,COMEPP'): a useful adjunct to diagnosis and therapy of severe personality disorders

ACTA PSYCHIATRICA SCANDINAVICA, Issue 3 2004
M. Fischer-Kern
Objective:, Pathogenous interpersonal (e.g. interfamilial) relationships and reference styles can compromise treatment efforts in severely disturbed (i.e. psychotic or borderline) patients. The integration of family- and individual-centred starting points may be useful in establishing interdisciplinary treatment concepts in these patients. Context-Oriented Model Development in Psychotherapy Planning (COMEPP) represents a diagnostic and therapy planning process, integrating both systemic and psychoanalytic conceptualizations. Method:, COMEPP is exemplified by the case of a young man with psychotic personality disorder who had previously been unresponsive to pharmacological and psychological treatment. Results:, After psycho-dynamical conflicts (i.e. primitive projective processes from the patient's mother to her son) had been elucidated during the COMEPP process, a sufficient treatment setting could be established. Conclusion:, COMEPP provides a psychotherapeutical approach to treatment planning on case-specific premises and may serve as an adjunct to concomitant pharmacological and psychological treatment strategies in so-called ,therapy refractory' patients. [source]

Computer-based psychological treatment for comorbid depression and problematic alcohol and/or cannabis use: a randomized controlled trial of clinical efficacy

ADDICTION, Issue 3 2009
Frances J. Kay-Lambkin
ABSTRACT Aims To evaluate computer- versus therapist-delivered psychological treatment for people with comorbid depression and alcohol/cannabis use problems. Design Randomized controlled trial. Setting Community-based participants in the Hunter Region of New South Wales, Australia. Participants Ninety-seven people with comorbid major depression and alcohol/cannabis misuse. Intervention All participants received a brief intervention (BI) for depressive symptoms and substance misuse, followed by random assignment to: no further treatment (BI alone); or nine sessions of motivational interviewing and cognitive behaviour therapy (intensive MI/CBT). Participants allocated to the intensive MI/CBT condition were selected at random to receive their treatment ,live' (i.e. delivered by a psychologist) or via a computer-based program (with brief weekly input from a psychologist). Measurements Depression, alcohol/cannabis use and hazardous substance use index scores measured at baseline, and 3, 6 and 12 months post-baseline assessment. Findings (i) Depression responded better to intensive MI/CBT compared to BI alone, with ,live' treatment demonstrating a strong short-term beneficial effect which was matched by computer-based treatment at 12-month follow-up; (ii) problematic alcohol use responded well to BI alone and even better to the intensive MI/CBT intervention; (iii) intensive MI/CBT was significantly better than BI alone in reducing cannabis use and hazardous substance use, with computer-based therapy showing the largest treatment effect. Conclusions Computer-based treatment, targeting both depression and substance use simultaneously, results in at least equivalent 12-month outcomes relative to a ,live' intervention. For clinicians treating people with comorbid depression and alcohol problems, BIs addressing both issues appear to be an appropriate and efficacious treatment option. Primary care of those with comorbid depression and cannabis use problems could involve computer-based integrated interventions for depression and cannabis use, with brief regular contact with the clinician to check on progress. [source]

Psychological treatment may reduce the need for healthcare in patients with Crohn's disease,

Psychogastroenterology: a call for psychological input in Australian gastroenterology clinics

INTERNAL MEDICINE JOURNAL, Issue 2 2009
A. Mikocka-Walus
Abstract Gastroenterologists should be able to refer patients directly to psychologists with full Medicare reimbursement. Psychological comorbidities are frequently seen in patients with gastrointestinal conditions. However, time pressure and lack of expertise in non-medical therapies of psychological problems prevent gastroenterologists from initiating psychological treatment although such treatment may improve patients' outcomes and reduce health-care utilization. Psychologists are needed as part of the multidisciplinary team in gastroenterology clinics in Australia to take the leading role in the psychological management of those patients by contributing to screening, faster diagnosis and treatment of depression and anxiety disorders in particular. [source]

A systematic review of the efficacy of non-pharmacological treatments for depression on glycaemic control in type 2 diabetics

JOURNAL OF CLINICAL NURSING, Issue 19 2008
Mei-Yeh Wang
Aims and objectives., This paper reported a systematic review of three randomised controlled clinical trials evaluating the efficacy of non-pharmacological treatment of depression on glycaemic control in individuals with type 2 diabetes. Background., Depression is associated with poor adherence to self-care regimen in individuals with diabetes. A significant relationship between depression and poor glycaemic control has also been suggested. Hence, the management of depression becomes an important aspect of diabetes care. Design., Systematic review. Methods., Cochrane library, Pubmed, MEDLINE, EBM review, ProQuest Medical Bundle and SCOPUS databases were searched using the following medical subject headings or key words , depression, mood disorder, depressive symptoms, diabetes mellitus, glycaemic control, glycated haemoglobin, glucose, psychological therapy, psychotherapy, non-pharmacological therapy and cognitive behaviour therapy. The publication date was limited from 1996,2007. Studies were selected if they used a randomised controlled trial design, were written in English, used non-pharmacological treatments for treating depression, included individuals with type 2 diabetes mellitus as participants and included depressive symptoms and glycaemic control (determined by haemoglobin A1C) as outcomes. Results., Non-pharmacological treatments of depression reduce depressive symptoms in diabetic patients. However, cognitive behaviour therapy did not improve glycaemic control. The treatment effect sizes for glycaemic control in the two collaborative-care programmes were also small. Conclusions., The available evidence indicated that non-pharmacological treatment of depression had limited effect on glycaemic control in individuals with type 2 diabetes. Relevance to clinical practice., The depression-focused interventions might not achieve optimal diabetes-related outcomes. The beneficial effect of psychological treatment for glycaemic control may be strengthened by employing treatments tailored to each individual's diabetes self-care needs in addition to depression management. [source]

Rural mental health and psychological treatment: a review for practitioners

JOURNAL OF CLINICAL PSYCHOLOGY, Issue 5 2010
K. Bryant Smalley
Abstract Practitioners in rural areas face particular challenges in providing psychological services, ranging from disparate rates of mental disorders to unique circumstances in treating special populations. In this article, we discuss the burden of mental disorders in rural areas, current trends in integration of mental health care and primary care, and unique concerns practitioners face in treating two special populations in rural areas (children and families, and older adults and their caregivers). Implications for practice are also discussed. © 2010 Wiley Periodicals, Inc. J Clin Psychol: In Session 66:1,11, 2010. [source]

Bipolar disorder: What can psychotherapists learn from the cognitive research?

JOURNAL OF CLINICAL PSYCHOLOGY, Issue 5 2007
Sheri Johnson
Randomized controlled trials of psychological treatment, principally cognitive therapy, for bipolar disorder have yielded inconsistent results. Given the status of this evidentiary base, we provide a more fine-grained analysis of the cognitive profiles associated with bipolar disorder to inform clinical practice. In this practice-friendly review, we consider evidence that both negative and positive cognitive styles are related to bipolar disorder. Cross-sectional and prospective evidence suggest that negative cognitive styles are related to depression within bipolar disorder, but there also is evidence that bipolar disorder is related to an elevated focus on goals as well as to increases in confidence during manic states. With such findings as backdrop, we consider the outcomes of psychological treatments for bipolar disorder and advance several suggestions for clinical practice. © 2007 Wiley Periodicals, Inc. J Clin Psychol: In Session 63: 425,432, 2007. [source]

Integration and coordination of pain management in primary care

JOURNAL OF CLINICAL PSYCHOLOGY, Issue 11 2006
John D. Otis
Pain is one of the most common symptoms reported to primary care providers and has significant implications for health care costs. The primary aim of this article is to describe and illustrate how to integrate the treatment of chronic pain in the primary care setting. First, we address the integration and coordination of care between mental health and primary care. We then present a typical case and discuss the patient's treatment, outcome, and prognosis. The article concludes with a discussion of issues that frequently arise when integrating psychological treatment for pain in primary care settings. © 2006 Wiley Periodicals, Inc. J Clin Psychol: In Session 62: 1333,1343, 2006. [source]

A critical evaluation of current views regarding eye movement desensitization and reprocessing (EMDR): Clarifying points of confusion

JOURNAL OF CLINICAL PSYCHOLOGY, Issue 1 2002
Byron R. Perkins
EMDR is an active psychological treatment for PTSD that has received widely divergent reactions from the scientific and professional community. This article examines points of confusion in the published literature on EMDR, including the theoretical, empirical, and historical issues around EMDR and placebo effects, exposure procedures, the eye movement component, treatment fidelity issues, and outcome studies. It also examines historical information relevant to the scientific process and charges of "pseudoscience" regarding EMDR. We conclude that the confusion in the literature is due to (a) the lack of an empirically validated model capable of convincingly explaining the effects of the EMDR method, (b) inaccurate and selective reporting of research, (c) some poorly designed empirical studies, (d) inadequate treatment fidelity in some outcome research, and (e) multiple biased or inaccurate reviews by a relatively small group of authors. Reading the original research articles frequently helps to reduce the confusion arising from the research review literature. © 2002 John Wiley & Sons, Inc. J Clin Psychol 58: 77,97, 2002. [source]

Integrating family therapy in adolescent depression: an ethical stance

JOURNAL OF FAMILY THERAPY, Issue 3 2009
Glenn Larner
Adolescent depression, particularly where suicidal behaviour is involved, is a complex and pressing mental health problem and demanding for families, therapists and services alike. This article reviews the evidence-based literature for adolescent depression including family therapy approaches. It suggests an integrative treatment approach that includes individual psychological treatment like CBT, medication where required and a family therapy intervention is supported by the literature. The focus of the latter is psychoeducation, building resilience and hope, enhancing communication, reducing relational conflict between parents and adolescents and addressing attachment and relationship issues. A systemic framework for integrating family therapy in the evidence- based treatment of adolescent depression is described. This is based on an ethic of hospitality towards different languages of therapy, which is illustrated by a detailed example from family therapy practice. [source]

Computerized cognitive,behaviour therapy for anxiety and depression: a practical solution to the shortage of trained therapists

JOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 5 2004
S. VAN DEN BERG bsc
Computerized cognitive,behaviour therapy (CCBT) programmes have been developed to help meet the enormous need for evidence-based psychological treatment of common mental health problems in the context of a severe shortage of trained therapists to meet that need. Randomized controlled trials have confirmed the efficacy of such programmes. We present the experience of a community mental health team (CMHT) resource centre with one such programme, Beating the Blues, together with outcome data on a small sample of its clients. We conclude that experience and data, taken together, demonstrate the practical benefits of CCBT in routine practice. [source]

Meta-Analysis of Studies with Missing Data

BIOMETRICS, Issue 2 2009
Ying Yuan
Summary Consider a meta-analysis of studies with varying proportions of patient-level missing data, and assume that each primary study has made certain missing data adjustments so that the reported estimates of treatment effect size and variance are valid. These estimates of treatment effects can be combined across studies by standard meta-analytic methods, employing a random-effects model to account for heterogeneity across studies. However, we note that a meta-analysis based on the standard random-effects model will lead to biased estimates when the attrition rates of primary studies depend on the size of the underlying study-level treatment effect. Perhaps ignorable within each study, these types of missing data are in fact not ignorable in a meta-analysis. We propose three methods to correct the bias resulting from such missing data in a meta-analysis: reweighting the DerSimonian,Laird estimate by the completion rate; incorporating the completion rate into a Bayesian random-effects model; and inference based on a Bayesian shared-parameter model that includes the completion rate. We illustrate these methods through a meta-analysis of 16 published randomized trials that examined combined pharmacotherapy and psychological treatment for depression. [source]

Psychological treatments for functional non-epileptic attacks: a systematic review

Eating disorders and multi-level models of emotion: An integrated model

CLINICAL PSYCHOLOGY AND PSYCHOTHERAPY (AN INTERNATIONAL JOURNAL OF THEORY & PRACTICE), Issue 4 2009
John R. E. Fox
Abstract This paper examines the relationship between emotions, depression and eating disorders. Initially, a review is undertaken of the current state of the research and clinical literature with regard to emotional factors in eating disorders. This literature is then integrated within a version of the multi-level model of emotion proposed by Power and Dalgleish. The aim of this paper is to incorporate a basic emotions, multi-modal perspective into developing a new emotions-based model that offers a theoretical understanding of psychological mechanisms in eating disorders. Within the new Schematic Propositional Analogical Associative Representation System model applied to eating disorders, it is argued that the emotions of anger and disgust are of importance in eating disorders and that the eating disorder itself operates as an inhibitor of emotions within the self. It is hoped that the development of a multi-levelled model of eating disorders will allow for the construction of number of specific testable hypotheses that are relevant to future research into the psychological treatment and understanding of eating disorders.,Copyright © 2009 John Wiley & Sons, Ltd. Key Practitioner Message: The central importance of emotions in eating disorders, and these emotions can operate over a number of cognitive levels of processing. [source]

Psychological Treatment and Medication for the Mood and Anxiety Disorders: Moderators, Mediators, and Domains of Outcome

The manualization of a treatment programme for personality disorder

CRIMINAL BEHAVIOUR AND MENTAL HEALTH, Issue 1 2005
Mary McMurran
Background The advantages of manualized psychological treatments include: the promotion of evidence-based practice, the enhancement of treatment integrity, the facilitation of staff training, and the potential replicability of treatment. Argument The manualization of a multi-component, multidisciplinary treatment programme for male personality-disordered offenders is described. The background to this development is explained and the treatment setting is described briefly, followed by a description of the eight treatment manuals: (1) the treatment overview, (2) Psychoeducation focusing on personality disorder diagnosis and core beliefs, (3) Trust and Self-awareness group exercises, (4) Stop & Think! - a social problem-solving intervention, (5) Controlling Angry Aggression, (6) Controlling Substance Use, (7) Criminal Thinking/Belief Therapy, and (8) Skills for Living - a social skills manual. Conclusions In addition to the original aims of manualization, this exercise has clarified the treatment programme, included less highly trained staff in the delivery of therapy and permitted the evaluation of treatment modules, thus contributing to the incremental evaluation of the overall programme. These manuals may usefully be shared with other practitioners in the field. Copyright © 2005 Whurr Publishers Ltd. [source]

Atypical depression: retrospective self-reporting of treatment effectiveness

ACTA PSYCHIATRICA SCANDINAVICA, Issue 3 2009
G. Parker
Objective:, Earlier studies demonstrated that those with atypical depression show a differentially superior response to monoamine oxidase inhibitor (MAOI) antidepressants. This study compares ratings of effectiveness for a range of treatments, amongst depressed subjects with and without atypical features. Method:, In an on-line survey, individuals experiencing likely clinical depression rated symptoms experienced when depressed, including ,atypical features' and the effectiveness of previous treatments. Mean treatment effectiveness ratings were compared amongst those with ,atypical depression' (n = 338) and ,non-atypical depression' (n = 377). Results:, There were few significant differences between the ,atypical depression' and ,non-atypical depression' groups in effectiveness ratings for drug treatments, and none for psychological treatments. The ,atypical depression' group had significantly lower mean effectiveness ratings for some selective serotonin reuptake inhibitor antidepressants. Few respondents had trialed MAOIs. Conclusion:, While MAOIs are rarely prescribed, a range of non-MAOI drug and psychological treatments are of some perceived benefit for depressed patients with atypical features. [source]

Group cognitive behavioural therapy for obsessive,compulsive disorder: a systematic review and meta-analysis

ACTA PSYCHIATRICA SCANDINAVICA, Issue 2 2009
H. Jónsson
Objective:, Behaviour therapy with exposure and response prevention (ERP) or cognitive behavioural therapy (CBT) including ERP are considered the psychological treatments of choice for obsessive,compulsive disorder (OCD), but group CBT/ERP has received relatively little research attention in the treatment of OCD. The aim of this study was to provide a meta-analysis of the effectiveness of group CBT/ERP for OCD. Method:, A systematic literature search was conducted and studies were meta-analysed by means of the Cochrane Review Manager Program with measures of i) pre- to post-effect sizes (ES) and ii) between-group ES in comparison with different control conditions. Outcome was primarily measured on the Y-BOCS and ES was calculated in the form of Cohens d. Results:, Thirteen trials were included in the meta-analysis. The overall pre,post-ES of these trials of 1.18 and a between-group ES of 1.12 compared with waiting list control in three randomized controlled studies indicate that group CBT/ERP is an effective treatment for OCD. Group CBT achieved better results than pharmacological treatment in two studies. One study found no significant differences between individual and group CBT. Conclusion:, Group CBT is an effective treatment for OCD, but more studies are needed to compare the effectiveness of group and individual treatment formats. [source]

The effectiveness of psychological treatments for treatment-resistant depression: a systematic review

Outcome of psychological treatments of pathological gambling: a review and meta-analysis

ADDICTION, Issue 10 2005
Ståle Pallesen
ABSTRACT Aims To investigate the short- and long-term effect of psychological treatments of pathological gambling and factors relating to treatment outcome. Design and setting This study provides a quantitative meta-analytical review of psychotherapeutic treatments of pathological gambling. Studies were identified by computer search in the PsycINFO and Medline databases covering the period from 1966 to 2004, as well as from relevant reference lists. Inclusion criteria The target problem was pathological gambling, the treatment was psychological, the study was published in English and outcomes directly pertaining to gambling were employed. Single case studies, studies where elimination of gambling not was the priority and studies with insufficient statistical information were excluded from the present meta-analysis. Participants A total of 37 outcome studies, published or reported between 1968 and 2004, were identified. Of these 15 were excluded, thus 22 studies were included, involving 1434 subjects. The grand mean age was 40.1 years. The overall proportion of men was 71.5%. Measurements The included studies were coded for outcome measures of pathological gambling. For each condition, means and standard deviations for gambling-related outcome measures, all based upon self-reports or therapist ratings, were compiled at three points in time: baseline, post-treatment and the last follow-up reported. Findings Effect sizes represent the difference between the mean score in a treatment condition and a control condition or the difference between mean scores at separated points in time for one group, expressed in terms of standard deviation units. At post-treatment the analysis indicated that psychological treatments were more effective than no treatment, yielding an overall effect size of 2.01 (P < 0.01). At follow-up (averaging 17.0 months) the corresponding effect size was 1.59 (P < 0.01). A multiple regression analysis showed that the magnitude of effect sizes at post-treatment were lower in studies including patients with a formal diagnosis of pathological gambling only, compared to studies not employing such inclusion criteria. Effect sizes were also higher in randomized controlled trials compared to not randomized controlled trials, higher in within subjects designs compared to between subjects designs and also positively related to number of therapy sessions. No mediator variables were significantly related to the magnitude of the effect sizes at follow-up. Conclusion Psychological interventions for pathological gamble seem to be yield very favourable short- and long-term outcomes. [source]

The epidemiology of depression in diabetes

EUROPEAN DIABETES NURSING, Issue 3 2008
K Winkley BSc, PhD Lecturer in Diabetes, Psychology
Abstract Depression is characterised by a period of low mood and loss of interest in everyday activities, and its prevalence in people with diabetes is thought to be twice as high as for those without the condition. Depression in diabetes is associated with a number of adverse outcomes such as increased morbidity, mortality and poor quality of life. As diabetes is increasingly common amongst the economically active, this has serious implications for health services and in the UK, the National Health Service (NHS) has recognised that depression in people with diabetes is a significant problem and recommends screening for depression in this group. Risk factors for depression in diabetes are almost identical to those in people without diabetes, but less is known about its course when people have diabetes, although the available evidence suggests it is more chronic. Research into the mechanisms by which depression is bad for people with diabetes suggests that biological, psychological and social factors play a part but the inter-relationships between these factors are likely to be complex and are not yet fully understood. Depression in people with diabetes can be treated successfully with pharmacological and psychological treatments at least in the short-term, but we do not yet know which treatments are successful in the long-term. Further research into the pathological mechanisms of depression and its treatment are needed if we are to continue to improve the health and lives of people with diabetes. Copyright © 2008 FEND [source]

Fatal outcome from extreme acute gastric dilation after an eating binge

INTERNATIONAL JOURNAL OF EATING DISORDERS, Issue 7 2006
Endre Gyurkovics MD
Abstract Objective: A 22-year-old woman is presented with acute gastric dilation after an eating binge, who died of complications of acute reperfusion syndrome. Method: A young patient was admitted in our clinic with critical condition without any significant previous medical history. Her initial complaints , diarrhea, vomiting and abdominal pain , began after an enormous food intake. There was no history of medications or toxic substances. Physical examination showed a normally-developed, well-nourished female in severe distress with an extremely distended abdomen. Femoral pulses were absent. The US and CT scan showed a dilated stomach, extended into the pelvis, dislocating the intestinal organs and compressed the aorta and mesenteric veins. Results: Urgent laparotomy was performed. An enormously distended stomach was encountered without volvulus, obstruction or adhesions. About 11 liters of gastric content was removed gastrotomy and nasogastric tube. Following the gastric decompression, the mesenteric and femoral pulses reappeared. During the operation, the cardio-respiratory status was stabilized, but in the following 24 hours irreversible shock developed, possibly due to the reperfusion of the retroperitoneal organs and the lower extremities. In the postoperative period disseminated intravascular coagulopathy developed. In an uncontrollable state of diffuse bleeding, 36 hours post-operation, the patient died. In retrospective investigation, the family confessed that previous psychological treatments which aimed at her bulimic attacks. Conclusion: Acute gastric dilatation is very uncommon and is of various etiologies, two of these being anorexia nervosa and bulimia. Several cases documenting complications of gastric dilatation were published; however, such severe complications, involving gastric infarction and compression of the aorta with ischemic injury of the bowels and lower extremities, are rare. © 2006 by Wiley Periodicals, Inc. Int J Eat Disord 2006 [source]

Effects of reminiscence and life review on late-life depression: a meta-analysis

INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 12 2003
Ernst Bohlmeijer
Abstract Aim To assess the effectiveness of reminiscence and life review on late-life depression across different target groups and treatment modalities. Method Twenty controlled outcome studies were retrieved from Psychlit, Medline and Dissertation Abstracts. For each study a standardised effect size, d, was calculated and a random-effects meta-analysis was conducted. Results An overall effect size of 0.84 (95% Confidence Intervals (CI)=0.31,1.37) was found, indicating a statistically and clinically significant effect of reminiscence and life review on depressive symptomatology in elderly people. This effect is comparable to the effects commonly found for pharmacotherapy and psychological treatments. The effect was larger in subjects with elevated depressive symptomatology (d=1.23) as compared to other subjects (d=0.37). Other characteristics of the subjects or interventions were not found to be related to increased or decreased effect sizes. Discussion Reminiscence and life review are potentially effective treatments for depressive symptoms in the elderly and may thus offer a valuable alternative to psychotherapy or pharmacotherapy. Especially in non-institutionalised elderly people,who often have untreated depression,it may prove to be an effective, safe and acceptable form of treatment. Randomized trials with sufficient statistical power are necessary to confirm the results of this study. Copyright © 2003 John Wiley & Sons, Ltd. [source]