Evaluating alcoholism treatment programs: An integrated approach.

Examines the interrelationships among 5 major sets of variables (social background, intake symptoms, program type, treatment experiences, and perceptions of the environment) that are related to posttreatment functioning of alcoholic patients (alcohol consumption, rating of drinking problem, physical impairment, and occupational functioning). The sample consisted of 429 patients selected from 5 different treatment programs. All Ss completed the Community-Oriented Program Evironment Scale about 2 wks after admission to measure their perceptions of the program environment. The relative importance of each set of variables as predictors of outcome was estimated by constructing block variables, using path analyses, and partitioning the explained variance. Results show that (a) the combined explanatory power of the program-related variables is considerably more than would be expected from previous research; (b) the importance of patient background relative to intake symptoms varies with the outcome criterion being used; (c) both the treatment experiences and the patient's perceptions of the treatment environment are strong predictors of outcome; and (d) a substantial proportion of the explained variance is shared between patient-related and program-related variables, suggesting important patient-program selection and congruence effects. (22 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychiatric CNS consultation model in a medical setting

This prospective follow-up study reports the outcome of children and adolescents discharged from short-term inpatient treatment based on teacher evaluations with Rutter's Questionnaire. There was a significant reduction in deviant behaviour between pretreatment and 5-month follow-up assessment but not between 5-month and 1-year follow-up. However, relatively few children fell within the normal range of non-clinically referred children. The child's more impaired general functioning, more frequent individual behaviour symptoms, antisociality and disengaged family interaction were associated with less favourable outcome. Pure affective or anxiety disorder predicted functioning within normal range and improvement in behaviour problems at follow-up. Treatment variables were not found to be associated with the outcome.     

A preliminary study of partial hospital management of severe obsessive-compulsive disorder

OBJECTIVE: The study examined the effectiveness of a partial hospital treatment program combining behavioral therapy, medication, and psychosocial intervention for severe and treatment-resistant obsessive-compulsive disorder. METHODS: A total of 58 patients with a primary diagnosis of obsessive-compulsive disorder who underwent treatment in a partial hospital program were assessed at baseline, at program discharge, and at six-, 12-, and 18-month follow-ups. Obsessive-compulsive symptoms, depression, anxiety symptoms, and global functioning were rated. RESULTS: The majority of patients (71 percent) met the criterion for a successful outcome, which was a 25 percent decrease in score on the Yale-Brown Obsessive Compulsive Scale (YBOCS). Fifty-five percent finished the program with YBOCS scores of 16 or less, indicating only mild symptoms. Most of these patients sustained their improvement at six, 12, and 18 months after discharge, and many showed further improvement with continued outpatient management. CONCLUSIONS: The partial hospital treatment program for obsessive-compulsive disorder appears to be an effective intervention that should be implemented and investigated further.     

Use of the Brief Psychiatric Rating Scale to measure success in a psychosocial day program

This study contrasted six subscales of the Brief Psychiatric Rating Scale (BPRS) to determine their sensitivity to psychosocial treatment outcome. An expanded version of the BPRS was administered to 216 clients on admission to a day program. The subscale measuring hostility and suspiciousness discriminated at intake clients who were therapeutically discharged from clients who did not complete the program and predicted discharge status after the investigators controlled for the effects of demographic variables. Significant reductions in scores were obtained on five subscales for a subset of clients to whom the BPRS was readministered before discharge. The results support the use of the expanded BPRS as an evaluative tool in psychosocial rehabilitation programs.     

The long-term course of severe anorexia nervosa in adolescents: survival analysis of recovery, relapse, and outcome predictors over 10-15 years in a prospective study

OBJECTIVE: To assess the long-term course of recovery and relapse and predictors of outcome in anorexia nervosa. METHOD: A naturalistic, longitudinal prospective design was used to assess recovery and relapse in patients ascertained through a university-based specialty treatment program. Patients were assessed semiannually for 5 years and annually thereafter over 10-15 years from the time of their index admission. Recovery was defined in terms of varying levels of symptom remission maintained for no fewer than 8 consecutive weeks. RESULTS: Nearly 30% of patients had relapses following hospital discharge, prior to clinical recovery. However, most patients were weight recovered and menstruating regularly by the end of follow-up, with nearly 76% of the cohort meeting criteria for full recovery. Relapse after recovery was relatively uncommon. Of note, time to recovery was protracted, ranging from 57-79 months depending on definition of recovery. Among restrictors at intake, nearly 30% developed binge eating, occurring within 5 years of intake. A variety of predictors of chronic outcome and binge eating were identified. There were no deaths in the cohort. CONCLUSION: The course of anorexia nervosa is protracted. Predictors of outcome are surprisingly few, but those identified are in keeping with previous accounts. The intensive treatment received by these patients may account for the lower levels of morbidity and mortality when considered in relation to other reports in the follow-up literature.     

Health locus-of-control beliefs and improvement in physical functioning in a work-hardening, return-to-work program.

Participants in a work-hardening, return-to-work program completed the Multidimensional Health Locus of Control (MHLC) Scale and were evaluated on five measures of physical functioning, both at intake and discharge. Using cluster analysis, five MHLC-profile types were identified at intake, and those with a combination of high beliefs in internal control and control by powerful others were found to show greater subsequent improvement from intake to discharge on one measure of physical functioning. In addition, three MHLC-change-profile types from intake to discharge were identified, and those showing an increase in beliefs in internal control also showed greater improvement from intake to discharge on two measures of physical functioning. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Posttreatment functioning of alcoholic patients: Its relation to program participation.

Assessed the posttreatment functioning of 429 alcoholic patients selected from 5 different types of residential treatment facilities. Substantial improvement in 3 areas of functioning (drinking, occupational, and psychological) occurred among patients in each of the programs, although there were significant differences among the programs in the level of functioning at intake and at follow-up. The extent to which posttreatment adjustment could be predicted from patients' sociodemographic and drinking characteristics at intake was estimated from multiple regression analyses: 15 to 33% of the variance of several posthospital performance criteria was explained. Measures of relative improvement (differences between actual and predicted posttreatment functioning) were obtained and showed some variation among the programs. Analyses relating relative improvement to the treatment experiences of the patients in each program demonstrated that (a) patients who participated more actively tended to have better than expected outcomes, (b) patients given more medications tended to function relatively more poorly at follow-up, and (c) patients given Antabuse had better than expected outcomes. (24 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Self-awareness, distress, and postacute rehabilitation outcome.

Objective: To examine changes in impaired self-awareness (ISA) and distress with participation in a brain injury comprehensive day treatment program (CDTP) and their relationship to treatment outcomes at program end and 1-year follow-up. Study Design and Participants: Ratings of ISA and distress by rehabilitation staff and their relationship to other outcome measures were examined for 62 consecutive program graduates. Measures: Ratings of ISA and distress from the Mayo-Portland Adaptability Inventory (MPAI); outcome measures included Rasch-transformed MPAI score, goal attainment scaling T score, the Vocational Independence Scale, and the Independent Living Scale. Results: Nonparametric analyses of change scores showed that ISA and distress diminished after program participation. Nonparametric correlational analysis indicated that reduced ISA did not correlate with increased distress at program end. Linear and logistic regression analyses revealed that lower ISA and distress correlated with more positive outcomes on most measures (i.e., independent living, goal attainment scaling, and other ratings of disability on the MPAI) but did not predict vocational outcome. Conclusions: Participation in a CDTP reduces ISA and distress. Lower ISA and distress are associated with positive behavioral changes and more independent living but are neither necessary nor sufficient conditions for employment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predictors of child psychological changes during family-based treatment for obesity

OBJECTIVE: To explore the influence of 1-year changes in child obesity and maternal psychopathology on changes in child psychological problems. DESIGN: Hierarchical regression models were used to predict child psychological change, with demographic variables, maternal psychological change, and child percentage overweight change as predictors. SETTING: Pediatric obesity research clinic. PARTICIPANTS: Clinic sample of 116 obese 8- to 12-year-old children and their mothers. INTERVENTIONS: Family-based behavioral weight-control program. MAIN OUTCOME MEASURES: Child psychopathology was assessed via mother-reported Child Behavior Checklists and maternal psychopathology was determined by standardizing scores on the Cornell Medical Index and the Symptoms Checklist-90-Revised. RESULTS: Significant improvements were observed in child percentage overweight (-20.1% overweight), and child and maternal psychopathology. Improved maternal psychopathology accounted for a significant amount of variance in improvements in the Child Behavior Checklist total Problems Scale and internalizing and externalizing problems subscales. Decreased obesity accounted for a significant amount of variance in improvements in the Total Competence scale and, somatic complaints, social problems and social competence subscales of the Child Behavior Checklist. Significant interactions of child obesity change by sex were found for Total Problems and externalizing scores. The interactions were due to girls with greater obesity reduction showing greater improvement in Total Problems, whereas boys with greater obesity reduction showed less improvement in externalizing problems. CONCLUSIONS: These results highlight the multidimensional nature of psychosocial functioning in obese children and call attention to multiple avenues for intervention to improve their psychosocial functioning.     

Avoidance coping strategies moderate the relationship between self-efficacy and 5-year alcohol treatment outcomes.

Both self-efficacy and coping strategies are important determinants of functioning for substance use disorder patients, yet little is known about their interrelationship. This study examined the relationship between abstinence self-efficacy and cognitive components of coping (positive reappraisal, cognitive avoidance) for male participants (n = 2,596) from 15 residential substance use disorder treatment programs who were assessed at treatment entry, discharge, and 5-year follow-up. Cognitive avoidance coping moderated the effects of self-efficacy on alcohol use at 5 years, whereas positive reappraisal coping was largely unrelated to outcomes. Specifically, for patients with low self-efficacy, reliance on avoidance coping strategies was associated with poorer alcohol use outcomes, but as self-efficacy increased, the negative influence of avoidance coping strategies diminished. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Contrast enhancement in the craniopharyngioma cyst wall caused by irradiation

OBJECTIVE: To determine the outcome of DSM-III-R schizophreniform disorder with good prognostic features. METHOD: A 6-year follow-up of 20 cases was conducted with structured interviews (comprehensive assessment of symptoms and history) and assessments of functioning scales (global assessment of functioning, Strauss-Carpenter Scale). RESULTS: Thirty-five percent of the cases had major affective disorders, 35% had schizophreniform episodes and major affective disorders, 5% had schizophreniform episodes only, 10% developed schizophrenia, and 15% had no disorders. CONCLUSION: The findings suggest an association between schizophreniform disorder with good prognostic features and affective illness.     

Cognitive-behavioral therapy and relationship therapy in the treatment of children referred for antisocial behavior.

112 children (aged 7-13 yrs) were randomly assigned to one of three treatments: problem-solving skills training (PSST), problem-solving skills training with in vivo practice (PSST-P), which included therapeutically planned activities to extend training to settings outside of treatment, or client-centered relationship therapy (RT). PSST and PSST-P children showed significantly greater reductions in antisocial behavior and overall behavior problems, and greater increases in prosocial behavior than RT children. These effects were evident on measures obtained immediately after treatment and at a 1-year follow-up, and on measures of child performance at home and at school. PSST-P children showed greater changes than PSST children on measures of functioning at school at posttreatment, but these differences were no longer evident at follow-up. Children in both PSST conditions showed significant reductions in deviant behavior and improvements in prosocial behavior from pretreatment to follow-up, whereas RT children tended to remain at their pretreatment level of functioning. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Long-term relationship between weight and aerobic-fitness change in children.

The relationship between changes in relative weight and fitness was assessed 5 years after children began treatment for obesity. Multivariate regression analysis showed that two factors were independently related to fitness change: (a) maintenance of weight loss from the end of 6 months of treatment to the 5-year follow-up and (b) initial fitness level. Children who showed the largest long-term changes in relative weight and the lowest initial fitness showed the largest improvements in fitness. Short-term weight loss was not related to long-term fitness change. These results show that weight loss and fitness are related over 5 years. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychoanalysis with avoidant personality disorder: A systematic case study.

This case study of process and outcome is based upon data obtained during a 5-year psychoanalysis of an adult male with avoidant personality disorder (AVPD). To date, no known systematic case studies, effectiveness studies, or randomized control trials exist for psychoanalysis in the treatment of AVPD. In this study, self-reported symptoms and observer-rated personality disorder (PD), global functioning, object relations, and psychological health were gathered at intake, after each year of treatment, and at 1-year follow-up. Process data was gathered to determine the extent to which the treatment adhered to prototypes of psychodynamic, cognitive-behavioral, and interpersonal therapy. Results indicated that the patient achieved clinically significant reductions in PD, symptom severity, and relational pathology. Gains were maintained at 1-year follow-up. The treatment significantly adhered to psychodynamic principles throughout, with some use of cognitive-behavioral and interpersonal principles in the third year of treatment. These findings warrant further investigation of psychoanalysis for AVPD and demonstrate the usefulness of assessing multiple domains of patient functioning and treatment process. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social skills training for primary school children: a 1-year follow-up study

OBJECTIVE: To evaluate the effectiveness of the Rochester Social Problem Solving Program to reduce emotional and behavioural problems amongst primary school children. METHODOLOGY: Children in years 3 and 4 at primary school were assessed prior to receiving the program, immediately after the program and 1 year after the program. At each assessment, the functioning of the children who received the program was compared to the functioning of children enrolled in years 3 and 4 at a comparable school who did not receive the program. RESULTS: The program improved the ability of children to cope with potentially difficult social situations. However, the program did not reduce the prevalence of teacher-reported or mother-reported childhood emotional and behavioural problems. CONCLUSIONS: School-based social skills programs may be more effective in reducing childhood emotional and behavioural problems if they include components which focus specifically on childhood behaviour problems as well as components focusing on social skills and peer relationships.     

Family functioning predicts outcomes for veterans in treatment for chronic posttraumatic stress disorder.

A longitudinal framework was used to examine the competing hypotheses of (a) whether family functioning predicts changes in posttraumatic stress disorder (PTSD) symptoms or (b) whether PTSD symptoms predict changes in family functioning. Veterans (N = 311) admitted to a treatment program completed a series of questionnaires at 3 time points: at intake, from intake to completion of a treatment program, and at the 6-month follow-up. Alcohol use and general mental health symptoms were also measured at intake. A cross-lagged panel model using structural equation modeling analyses indicated that family functioning was a moderate predictor of PTSD symptoms at posttreatment and at the 6-month follow-up. PTSD was not a significant predictor of family functioning across time and alcohol use, and general mental health symptoms did not affect the overall findings. Further analyses of PTSD symptom clusters indicated that the avoidance symptom cluster was most strongly related to family functioning. Targeting family relationships for treatment may be important in the future for veterans with PTSD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A controlled comparison of psychiatric day treatment and inpatient hospitalization.

59 seriously ill, female, 16-72 yr old psychiatric patients were randomly assigned, after 2-6 wks of inpatient evaluation, to an inpatient or day service where they were evaluated, along with a control group of 34 "usual" day hospital patients, for up to 24 mo. Data from the Psychiatric Status Schedule, Psychiatric Evaluation Form, Dynamic Assessment Scale, and other similar measures indicate that for the range of patients studied, day treatment is, on the whole, superior to inpatient treatment in 5 distinct areas: subjective distress, community functioning, family burden, total hospital cost, and days of attachment to the hospital program. The findings of other controlled studies are confirmed and extended to include previously unreported outcome dimensions and a broader socioeconomic population. (25 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Outcomes of inpatients treated on a VA psychiatric unit and a substance abuse treatment unit

OBJECTIVE: The utility of the Treatment Outcome Profile (TOP) for measuring the effectiveness of acute inpatient psychiatric and substance abuse treatment was tested, including its internal reliability, validity, and sensitivity to treatment gains. The relationship between patients' satisfaction with services and treatment gains in quality of life, symptoms, and level of functioning was explored. METHODS: A pre-post research design was used with consecutive admissions to an inpatient psychiatric unit (N = 66) and a substance abuse treatment unit (N = 88) at a VA medical center. At admission and at discharge, the TOP, a self-report instrument assessing quality of life, symptoms, level of functioning, and patient satisfaction with services (at discharge only) was completed. Multivariate analysis of variance and univariate analysis of variance were used to test differences in scores between admission and discharge. RESULTS: Patients demonstrated significant treatment gains. Overall, compared with patients on the substance abuse unit, those receiving psychiatric treatment were more impaired at admission and had lower levels of self-reported therapeutic gain at discharge. Improvement for both groups occurred in quality of life, symptoms, and level of functioning. Both groups reported high levels of patient satisfaction, comparable with levels in other service industries. A high positive correlation (alpha = .61) was found between patient satisfaction and overall self-reported treatment gain. CONCLUSIONS: The results indicate that it is important to compare treatment effectiveness as well as costs when seeking less costly alternatives to inpatient care. The TOP is a valid and sensitive outcome measurement tool. Patient satisfaction is an important outcome variable and positively related to treatment gains in quality of life, symptoms, and level of functioning.