Psychotherapy for intractable inflammatory dermatoses

BACKGROUND: Most patients with inflammatory dermatoses respond to conventional treatment. Recalcitrance may indicate underlying emotional factors after infection, contact allergy, and noncompliance have been ruled out. Psychiatric treatment has been reported to be effective. OBJECTIVE: The purpose was to determine whether insight-oriented psychotherapy, by effecting last change, would provide long-term cutaneous and psychiatric improvement. METHODS: On the basis of emotional distress attributed to a recalcitrant inflammatory dermatosis, four patients were referred for psychiatric evaluation. The effect of adding insight-oriented psychotherapy as the only change in the treatment regimen of each patient was studied. Each patient served as his or her own control. RESULTS: In each patient clearing of the previously recalcitrant dermatosis accompanied psychiatric improvement. CONCLUSION: In selected cases of recalcitrant inflammatory dermatoses, insight-oriented psychotherapy may provide lasting cutaneous improvement and improved life adjustment and psychologic well-being.     

Treating mother and baby in conjoint hospitalization in a psychiatric hospital

Since 1990 we have been admitting mothers with postpartum psychiatric morbidity together with their babies to our open psychiatric ward. The aim of conjoint hospitalization is to maintain and develop the bond between mother and baby while treating the mother's psychiatric disorder. The presence of the infant in the hospital allows both a thorough evaluation of the mothers' maternal ability and to use the infant as a facilitator of the mothers' recovery by engaging maternal functions. It prevents the infants from being placed in a foster home for the duration of the mothers' hospitalization. Readily available in Britain and Australia, such conjoint hospitalization is controversial and rarely available elsewhere. In the past 5 years we hospitalized 10 women with 11 babies (1 woman was hospitalized twice, after different births). All women had received psychiatric treatment prior to childbirth, but this was the first psychiatric hospitalization for 2 of them. Diagnoses (DSM-IIIR) were chronic paranoid schizophrenia (4), affective disorder (4), schizo-affective schizophrenia (1) and borderline personality disorder (1). 8 were suffering from active psychotic symptoms on admission. They were treated pharmacologically, received individual and group psychotherapy, and participated in all ward activities. Families were engaged in marital, family and/or individual therapy according to need. All participated in cognitive-behavior treatment tailored to individual need to build and enrich the mother-infant bond. All improved significantly and were able to function independently on discharge, but in 1 case adoption was recommended.     

Patient coordination: Contrasts with other conceptualizations of patients' contribution to the alliance and validity in insight-oriented psychotherapy.

Describes how the patient coordination construct contrasts with the bond and collaboration conceptualizations of the alliance and reports on an initial investigation of the validity of patient coordination in the context of insight-oriented psychotherapy. In contrast with other approaches, the coordination construct focuses on the kinds of complex defensive patterns that appear prominently in clinical discussions of problematic patient behavior. Data consisted of audiotaped therapy sessions with 16 male college students and 9 psychiatric inpatients. As predicted, the group of relatively higher functioning outpatients was significantly more coordinating in interpersonal behavior in therapy than the more seriously disturbed hospitalized patients. In another comparison, patients in therapy with experienced therapists were significantly more coordinating than patients treated by untrained therapists. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prevalence and geographical distribution of Giardia spp. and Cryptosporidium spp. in dairy farms in Québec

Many patients with psychotic disorders lack awareness of being ill. This often presents a serious impediment to treatment compliance. We hypothesized that exposing partially remitted patients to videotapes of themselves, made while they were acutely psychotic, might increase their insight into the nature of their illness. Eighteen acutely psychotic inpatients were assigned randomly to a control or experimental group and interviewed on videotape 24 to 48 hours after admission, using scales that measure insight (Insight and Treatment Attitudes Questionnaire [ITAQ]) and psychopathology (Brief Psychiatric Rating Scale [BPRS]). One to six weeks later, when judged to be significantly improved, subjects were shown either a videotape of their initial interview (experimental group) or a placebo videotape (control group) and then reinterviewed 24 to 48 hours later on videotape, using the BPRS and ITAQ scales. Evaluation of initial and final ITAQ and BPRS scores revealed significantly greater improvement in insight scores and in delusionality in the experimental group. However, no significant difference in overall psychopathology was seen for the two groups. These results suggest that exposure of hospitalized patients to videotapes of their own psychotic behavior may be a cost-effective therapeutic tool for developing personal insight into psychotic illness.     

Occurrence and clinical correlates of psychiatric comorbidity in patients with psychotic disorders

BACKGROUND: The aim of this study was to explore patterns and clinical correlates of psychiatric comorbidity in patients with schizophrenia spectrum disorders and mood spectrum disorders with psychotic features. METHOD: Ninety-six consecutively hospitalized patients with current psychotic symptoms were recruited and included in this study. Index episode psychotic diagnosis and psychiatric comorbidity were assessed using the Structured Clinical Interview for DSM-III-R-Patient Version (SCID-P). Psychopathology was assessed by the SCID-P, Brief Psychiatric Rating Scale, Scale for the Assessment of Negative Symptoms, and Hopkins Symptom Checklist. Awareness of illness was assessed with the Scale to Assess Unawareness of Mental Disorders. RESULTS: The total lifetime prevalence of psychiatric comorbidity in the entire cohort was 57.3% (58.1% in schizophrenia spectrum disorders and 56.9% in mood spectrum psychoses). Overall, panic disorder (24%), obsessive-compulsive disorder (24%), social phobia (17.7%), substance abuse (11.5%), alcohol abuse (10.4%), and simple phobia (7.3%) were the most frequent comorbidities. Within the group of mood spectrum disorders, negative symptoms were found to be more frequent among patients with psychiatric comorbidity than among those without comorbidity, while such a difference was not detected within the group of schizophrenia spectrum disorders. Social phobia, substance abuse disorder, and panic disorder comorbidity showed the greatest association with psychotic features. An association between earlier age at first hospitalization and comorbidity was found only in patients with unipolar psychotic depression. Patient self-reported psychopathology was more severe in schizophrenia spectrum patients with comorbidity than in those without, while such a difference was less pronounced in mood spectrum psychoses. CONCLUSION: These findings suggest that psychiatric comorbidity is a relevant phenomenon in psychoses and is likely to negatively affect the phenomenology of psychotic illness. Further studies in larger psychotic populations are needed to gain more insight into the clinical and therapeutic implications of psychiatric comorbidity in psychoses.     

Thought disorder in adolescent-onset schizophrenia

The nature of the thinking disturbances found in adolescent-onset psychotic conditions is not as well-characterized as the thought disorders found in adult psychotic patients. We used the Thought Disorder Index to examine whether schizophrenic patients in whom psychotic symptoms appear in adolescence show the same characteristic features of thought disorder as do adult schizophrenics. Quantitative and qualitative features of thought disorder were assessed in psychiatric inpatients with adolescent-onset schizophrenia, psychotic depression, and nonpsychotic conditions compared with normal control adolescents. Elevated thought disorder occurred in all groups of adolescents hospitalized for an acute episode of psychiatric illness. The magnitude of the elevation and the frequency of occurrence of disordered thinking were greatest in the psychotic adolescents. The qualitative features of the thought disturbances found in the schizophrenic adolescents were distinct from those observed in adolescents with psychotic depression. The thinking of the schizophrenic adolescents resembled that of adult schizophrenics. In both conditions thought disorder is characterized by idiosyncratic word usage, illogical reasoning, perceptual confusion, loss of realistic attunement to the task, and loosely related ideas.     

Clinical dilemmas in contemporary psychotherapy: The search for clinical wisdom.

Examines the concept of the clinical dilemma in the contemporary practice of psychotherapy. The notion of "dilemma management" by the psychotherapist is viewed as a ubiquitous phenomenon in the psychotherapeutic process. Dilemmas in a range of areas of clinical practice are discussed. These include (1) differing treatment modalities, such as insight-oriented psychotherapy, behavior therapy, marital and family therapy, and group therapy; (2) systemic issues such as spousal codependency and family homeostasis; (3) transference and countertransference; (4) therapeutic neutrality and management of the therapeutic boundary; and (5) psychological assessment and psychiatric diagnosis. Finally, observations are made about the interpersonal process of dilemma management in psychotherapy that models for patients an effective way of approaching the pervasive conflicts and dilemmas in their own lives. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Rey-Osterrieth Complex Figure Test performance in acute, chronic, and remitted schizophrenia patients

To assess visual memory disturbance in different forms of schizophrenia, we compared Rey-Osterrieth Complex Figure Test (RCF) performance in acutely psychotic, chronically psychotic, and outpatient schizophrenia patients and in a control group of acutely psychotic patients with disorders other than schizophrenia. There were no group differences on the copy condition of the RCF. The chronic schizophrenia group utilized more abnormal copying strategies, however, than the outpatient or nonschizophrenia groups. Moreover, the chronic schizophrenia group demonstrated significantly poorer recall than the outpatient or nonschizophrenia groups, and a trend toward poorer performance than the acute schizophrenia group. Both groups of inpatient schizophrenia patients were characterized by a lack of relationship between copying strategies and recall accuracy. These data suggest that (a) chronic schizophrenia patients are characterized by more severe memory impairment than are nonchronic schizophrenia patients, and (b) visual memory disturbance in chronic schizophrenia is not solely a function of encoding difficulties.     

Factors associated with multiple admissions to a public psychiatric hospital

The purpose of this study was to identify the psychiatric and social factors associated with multiple admissions, especially for psychotic patients. Demographic and diagnostic information (based on the DSM-III-R) was collected on a computerized database for all patients admitted to the only psychiatric hospital in Geneva, Switzerland. Patients who had had at least three admissions over a period of 1 year were compared with a control group drawn from the total clinic population. In 1994, a total of 1575 patients were hospitalized, and 18% of these patients were readmitted for the third or more time. The principal diagnoses were psychotic disorders (25%), affective disorders (35%) and substance-related disorders (24%). The predictors of multiple admissions for psychotic patients were a comorbidity of substance-related disorder, longer duration of illness, female sex, younger age and poorer psychosocial adjustment during the past year. These results highlight the usefulness of a computerized psychiatric database. Indeed, early identification of the types of psychiatric patient who are likely to be readmitted is necessary to enable the planning and implementation of specific programmes of ambulatory care to prevent rehospitalization.     

Psychiatric hospitalization of adolescents for conduct disorder

OBJECTIVE: The authors' goal was to review current published literature on the psychiatric hospitalization of adolescents with a diagnosis of conduct disorder. METHODS: The English-language literature from 1980 to 1991 cited in the MEDLINE database was searched using the key words conduct disorder, adolescent psychiatric hospitalization, psychiatric hospitalization criteria, adolescent psychiatric inpatient hospitalization, and adolescent psychiatric admissions. RESULTS: A diagnosis of conduct disorder or presenting symptoms and behaviors consistent with that diagnosis are commonly reported for adolescent psychiatric admissions. Estimates of the percentage of admissions to psychiatric inpatient treatment facilities of adolescents with conduct disorder or symptoms consistent with that disorder range from 30 to 70 percent. There are no research-based criteria for hospitalization of adolescents for conduct disorder, and systematic studies of the outcome of psychiatric hospitalization for this group have not been published. Comorbid psychiatric diagnoses and similar behavioral symptoms in conduct disorder and comorbid disorders complicate inpatient treatment of adolescents with conduct disorder. CONCLUSIONS: Studies of the outcome of psychiatric hospitalization of adolescents for conduct disorder are needed to determine the appropriate use of this modality.     

The effect of therapists' training on group therapeutic outcome.

The outcome of group therapy for psychotic patients was used as the dependent variable in assessing the comparative efficacy of trained and untrained therapists. The latter were undergraduate students with no training or experience in psychotherapy. For this reason, their role in psychotherapy was viewed as analogous to that of a placebo in studies assessing drug effects. Changes in psychological test performance of 295 patients before and after 5 mo. of group therapy served as the criterion of therapeutic behavior change. By comparison to an untreated control group the lay therapists achieved slightly better results than psychiatrists and psychiatric social workers doing group therapy with similar patients. Caution is urged in extending the implications of these results beyond group therapy with schizophrenic patients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Behavioral versus insight-oriented marital therapy: Effects on individual and interspousal functioning.

Compared the effects of behavioral marital therapy (BMT) and insight-oriented marital therapy (IOMT) on both interspousal and intrapersonal functioning in a controlled outcome study. A total of 79 couples seeking treatment for relationship distress were randomly assigned to BMT, IOMT, or a treatment-on-demand (TOD) waiting-list control group. Results indicated the significance and general equivalence of behavioral and insight-oriented therapies in producing positive changes in individual and relationship functioning. Both treatment approaches produced significant effects from intake to termination that were substantially maintained at the 6-month follow-up. Behavioral and insight-oriented therapies resulted in significant improvements in self-reports of global marital accord and, to a lesser extent, in the reduction of overall psychological distress and in the enhancement of self-concept, with no significant differences between treatment conditions. The magnitude of these effects in comparison with those reported in previous marital outcome studies and in more general psychotherapy research is discussed, and possible mechanisms for the equivalence of these technically divergent treatment approaches are explored. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The psychotherapy of schizophrenia: Patient and therapist factors related to continuance.

The influence of pretreatment patient and therapist characteristics on continuance in individual psychotherapy was investigated using a sample of 143 nonchronic schizophrenic patients. Results showed that 1) most of the usual indicators of patient suitability for psychotherapy were not related to continuance; 2) patients with positive symptoms of schizophrenia were most likely to remain in supportive therapy, whereas patients with negative symptoms were more likely to remain in insight-oriented therapy; and 3) all patients were more likely to continue in treatment with therapists who had a strong commitment to a well-defined treatment approach, be it supportive or insight oriented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Back to basics: The importance of focus selection.

Examines the importance of selecting a therapeutic focus when teaching the introductory course in brief insight-oriented psychotherapy to psychiatric residents. The initial attention required toward the selection of a focus, and adherence to this central theme during treatment, are the essential features of the brief therapeutic technique. Case material from a 68-yr-old man provided by a resident illustrates the process of finding a therapeutic focus. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Distinctiveness of behavioral versus insight-oriented marital therapy: An empirical analysis.

The present study determined whether behavioral and insight-oriented marital therapy could be rendered in a distinct and uncontaminated fashion in manual-guided outcome research in which therapists were crossed with treatment condition. Results indicated that therapist interventions could be reliably coded into techniques specific to the respective approaches and into additional interventions not specific to either treatment modality. When provided with explicit treatment manuals and ongoing case supervision, therapists were able to administer both treatment conditions faithfully without contamination from techniques that were inconsistent with that theoretical approach. Behavioral marital therapy (BMT) was shown to be highly structured, with 93% of therapist interventions reflecting techniques specific to that approach. In contrast, insight-oriented marital therapy (IOMT) comprised a large percentage of nonspecific interventions (62%) compatible with but not unique to a psychodynamic orientation. Implications for the two treatment approaches and for future marital therapy outcome research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Videoscopic resection of a thrombosed aneurysm of a patent ductus arteriosus in a neonate

OBJECTIVE: In the wake of the U.S. Supreme Court's 1990 decision in Zinermon v. Burch, renewed attention has been given to capacities patients must have to be considered competent to consent to voluntary hospitalization. An American Psychiatric Association (APA) task force suggested that strong policy interests support the establishment of a low threshold for competence in this situation. The study examined whether, as previous research suggested, patients would have difficulty meeting even this lenient standard. METHODS: One hundred voluntarily hospitalized psychiatric patients were read two brief paragraphs, one explaining the purposes of psychiatric hospitalization and and the other explaining policies for discharge. The paragraphs' readability measured about eighth-grade level. After each paragraph, participants were read two sets of questions, one testing recall of the presented information and the other testing recognition of the information in a true-false format. The scores of patients grouped by selected demographic and clinical variables were compared. RESULTS AND CONCLUSIONS: The vast majority of patients were able to comprehend the information that the APA task force suggested was relevant to their decision. However, a subgroup of patients who were initially admitted involuntarily had significantly poorer performance and may constitute a group who need special educational efforts focused on the consequences of voluntary admission.     

A test of Chapman's theory of schizophrenic thought disorder.

Tested the validity of L. J. Chapman's (1964) theory of schizophrenic thought disorder. The vocabulary test from the Shipley-Institute of Living Scale for Measuring Intellectual Impairment served as the control task, and the multiple-choice vocabulary test used by T. B. Boland and L. J. Chapman (see record 1972-03368-001) to disclose a schizophrenic deficit related to thought disorder served as the experimental task. Two groups of 97 hospitalized psychiatric patients, one group classified as schizophrenic and the other as psychiatric controls, served as Ss. Both groups performed below the normal level reported by Boland and Chapman but somewhat above the mean level of the chronic schizophrenics they tested. The schizophrenic group in this study did not perform differently from the psychiatric controls on the experimental task. Results indicate that some factor other than schizophrenic thought disorder was being measured by the experimental task. (28 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treatment of anxiety through systematic desensitization in therapy groups.

The effects of short-term treatment by modified systematic desensitization in time-limited intensive therapy groups were evaluated in a matched groups design. 10 chronically anxious college males, treated by the group method, were evaluated on the basis of personality and anxiety scales against an "own-control" period, and 4 equated groups of 10 Ss each. 1 group served as an untreated control for evaluating extra-treatment effects on college grade-point average, as an objective, public criterion. Ss in the remaining groups received 1 of the following individual treatments: systematic desensitization, insight-oriented psychotherapy, or an attention-placebo treatment. The group method produced several significant improvements, suggesting that combined group desensitization offers an efficient and effective treatment for social-evaluative anxiety. (27 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)