Affect translation in the psychotherapy of psychosis: Semrad's approach revisted.

Although psychotherapy has been deemphasized in recent years as a treatment modality in psychosis, it is clear that biological intervention alone does not restore patients to purposeful psychosocial functioning. In this article psychosis is viewed as being organized affectively, and a specific model of psychotherapy, first put forward by Elvin Semrad, is suggested to have clinical utility in this effort. This model is one of affect translation, and specific techniques in its use are explicated via case illustrations. How psychosis is organized and what affect translation accomplishes is also discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Political and psychosocial issues in psychotherapy for spouse abusers: Implications for treatment.

Considers and evaluates political and psychosocial factors that impact the delivery of psychotherapy for male spouse abusers in light of the perceived clinical need for such services. Objections to providing psychotherapy for spouse abusers are viewed as emanating primarily from conflicting philosophical definitions of the problem. A proposed model of spouse abuse seeks to integrate findings from the literature and experience to reduce the conflict between diverse philosophical positions. The model identifies 3 areas in which intervention can decrease the likelihood of spouse abuse: social attitudes in the larger environment, the man's individual characteristics and attitudes, and the nature of the interactions between the man and his spouse. Guidelines presented attempt to maximize psychotherapy effectiveness and reconcile political and psychosocial issues. It is suggested that the assailant is solely responsible for the physical violence. Although social attitudes, environmental events, and individual characteristics all interact to increase the probability of wife battering, intervention with the assailant is considered critical. (28 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychological adjustment among African American breast cancer patients: One-year follow-up results of a randomized psychoeducational group intervention.

The effectiveness of support group interventions for cancer patients has been established among White patients but has been virtually unstudied among minority patients. The current study represents the 1st randomized support group intervention targeted to African American women with breast cancer. Participants (N = 73) with nonmetastatic breast cancer were randomly assigned to an 8-week group intervention or an assessment-only control condition At 12 months, the intervention resulted in improved mood as well as improved general and cancer-specific psychological functioning among women with greater baseline distress or lower income. Subsequent research is needed to address effective methods of enrolling and following women with fewer psychosocial and financial resources, as they were the most likely to benefit from this particular intervention. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Substance abuse issues in cancer patients. Part 1: Prevalence and diagnosis

Although rare, drug abuse problems present a complex set of physical and psychosocial issues that complicate cancer treatment and pain/ symptom management. Most oncologists are not be well versed in either the conceptual or practical issues related to addiction. As a result, they often struggle in their attempts to effectively treat patients who are or have been substance abusers, and they find it difficult to understand issues of addiction in patients with pain who have no history of substance abuse. In the first installment of a two-part series, the authors explore the epidemiology of substance abuse. An examination of the distinctions between abuse and dependence leads to definitions of these terms appropriate for the oncology setting. Guidelines for assessing aberrant drug-taking behavior are also offered. Part 2, which will appear in the next issue of ONCOLOGY, will discuss the clinical management of cancer patients with a history of substance abuse.     

Utilization of ambulatory psychotherapy by patients with endogenous depression after inpatient psychiatric treatment

The long-term course of major depressive disorder is often accompanied by relapses or chronicity. Since psychosocial factors have been shown to be important predictors for the long-term outcome, psychotherapy along with drug therapy belongs to the standard methods of treatment. In spite of the effectiveness of psychotherapy, only some of the inpatients are treated with outpatient psychotherapy after hospital discharge. Within the framework of the Heidelberg depression study the authors examined what kind of, how many and for how long endogenously depressed patients sought out-patient psychotherapy after an inpatient treatment in a two-year follow-up. During the follow-up one half of patients were treated with outpatient psychotherapy. They were found to be younger, had suffered from more previous episodes, and their personality was more disturbed than those who had not undergone psychotherapy. The Expressed Emotion index did not make any further difference, whereas certain aspects of partnership quality did. The distinction between the two groups of patients is discussed regarding possible selection processes by treatment indication. It is pointed out that research on synergistic cooperation between members of the mental health services is highly desirable.     

Wounded healer: Psychotherapist grief over a client's death.

Psychotherapy with a patient who is seriously or terminally ill presents the psychologist with many challenges. This article describes the psychotherapy of a client in treatment for cancer. The author outlines the case and examines how ethical challenges and countertransference issues were important considerations in working with the client. Recommendations for psychologists who are providing psychotherapy to seriously or terminally ill patients are then offered. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Cancer, emotional responses and cognitive behavioural psychotherapy

Cancer and its treatment is known to have a substantial psychological morbidity and, while adjuvant psychological therapy (APT) is well established, relatively little work has been done to investigate the effectiveness of psychotherapy, particularly cognitive behaviour therapy (CBT), for patients with cancer. This article focuses initially on emotional responses to the diagnosis of cancer, individual vulnerability and the prevalence of psychological problems in patients with cancer. The use of cognitive behaviour therapy is then described, together with key issues in its application and specific problems. The work concludes by considering differences in applying CBT to patients with cancer compared to patients with other physical illnesses and the notion of 'relapse inoculation'.     

Rehabilitation treatment of sexuality issues due to acquired brain injury.

Brain injury can cause myriad deficits that affect an individual's sexuality. Sexuality has not been given much attention in the rehabilitation process. It is important for the rehabilitation team to treat psychosocial and sexual issues before the individual reenters the community. Treatments of psychosocial–sexual issues include sex education groups for survivors and families, social skills groups, individual and group psychotherapy, community skills training, and medication. These approaches can play an important role in helping survivors and their families cope with sexuality issues after brain injury and, thus, can increase self-awareness and decrease disinhibited behaviors. Three case studies describe sexuality issues and highlight the importance of awareness and the relationship between awareness and outcome. Treatment provides the survivor and family with information about how to discuss sexuality issues and teaches the survivor effective interaction skills so as to reduce unwanted sexual behaviors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Time to let go of the illusion that psychotherapy extends the survival of cancer patients: Reply to Kraemer, Kuchler, and Spiegel (2009).

Replies to comments from Kraemer, Kuchler, and Spiegel (see record 2009-02580-001) on the authors original article Psychotherapy and survival in cancer: The conflict between hope and evidence (see record 2007-06095-001). The authors recently reviewed evidence related to the notion that psychotherapy extends survival in cancer patients (J. C. Coyne, M. Stefanek, & S. C. Palmer, 2007). The authors found that no study to date, including several designed and powered to test this hypothesis, can be reasonably interpreted as evidence that cancer patients live longer as a result of receiving psychotherapy. The authors concluded that the evidence against psychotherapy as a life-prolonging intervention in cancer is sufficiently robust to discontinue funding studies in this area. H. C. Kraemer, T. Kuchler, and D. Spiegel (2009) critiqued the authors' review. The authors respond directly to numerous misrepresentations made by Kraemer et al. More importantly, the authors provide readers with an accurate overview of the main issues being debated and the reasons for their conclusions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attitudes of Canadian oncology practitioners toward psychosocial interventions in clinical and research settings in women with breast cancer

The aim of this study was to survey Canadian oncology practitioners' attitudes toward psychosocial concerns and issues in women with breast cancer. Surveys were mailed to 351 medical, radiation and surgical oncologists and 375 oncology nurses. Standard questionnaires assessed attitudes towards psychosocial issues in women with primary and metastatic breast cancer and evaluated the practitioners' willingness to refer women to psychosocial intervention trials in the presence and absence of competing drug trials. Responses were obtained from 74% of those surveyed. Respondents reported being aware of the common occurrence of psychosocial problems in women with metastatic breast cancer, however, physicians were less likely than nurses to offer these women psychosocial support on a prophylactic basis (p < 0.0001) and they expressed greater concern than nurses about scientific validity of (p = 0.0003), and potential psychological damage from (p = 0.005), psychosocial support groups. Nurses were more likely than physicians to favour a study investigating group psychosocial support over competing drug studies (p < or = 0.003) in the metastatic setting. Physicians were less likely than nurses to deal with weight problems prophylactically in women with primary breast cancer (p = 0.0009) and they expressed greater concern over scientific validity of psychosocial interventions addressing weight than nurses (p = 0.0008); nurses were more concerned about excessive expectations of patients regarding potential benefits of such interventions (p < 0.0001). Regardless, nurses were more likely than physicians to favour a psychosocial intervention study focused on weight management over drug studies in pre- (p = 0.0006) and postmenopausal women (p = 0.05) with primary breast cancer. Canadian oncology practitioners are aware of the common occurrence of psychosocial distress in women with breast cancer. Physicians and nurses assigned differing priorities to psychosocial interventions in both clinical and research situations.     

Vascular access survival among incident hemodialysis patients in the United States

OBJECTIVES: To investigate: (i) if early psychosocial intervention after cystectomy for bladder cancer can assist psychosocial rehabilitation; (ii) if the outcome of such intervention correlates with the patient's psychological defensive strategies as revealed with the meta-contrast technique (MCT); and (iii) if the patient's general philosophical outlook is important in this context. PATIENTS AND METHODS: Of 50 patients who had undergone radical cystectomy for bladder cancer, 17 received an ileal conduit, 17 a continent urinary reservoir with abdominal stoma and 16 an orthotopic neobladder. Twenty-four of the patients were randomized to psychosocial intervention, comprising weekly counselling 4-9 weeks after surgery. All patients were then evaluated with the Sickness-Impact Profile (SIP) standard questionnaire and the MCT (a projective test of percept-genetic model) was used to reflect individual defensive strategies at the subconscious or unconscious level. The patient's general philosophical outlook was recorded before and after surgery. RESULTS: There was no significant difference in the results of the SIP between the intervention and the non-intervention group, as a whole or in its psychosocial dimension. However, intervention benefited patients with continent cutaneous diversion, whose scores on the psychosocial SIP dimension were lower than in the groups with ileal conduit diversion or orthotopic bladder replacement (P < 0.05). The MCT analysis of defensive strategies identified three clusters of patients characterized mainly by isolation and repression, repression and stereotypy or sensitivity and stereotypy. Analysis for cluster identification showed no significant SIP score differences between intervention and non-intervention groups. In an analysis of single defensive strategies, stereotypy was associated with higher total SIP score, but not significantly. Three clusters of philosophical outlook were identified; in one cluster, characterized by a belief in a supernatural power and philosophical interest, the psychosocial SIP scores were lower in the patients who obtained emotional support and the reverse in a cluster with contrary attitudes, although neither differences were significant. CONCLUSION: Psychosocial intervention assisted the psychosocial rehabilitation of patients with continent cutaneous urinary diversion. Defensive strategies and philosophical outlook generally did not influence the outcome of intervention. However, such programmes may be helpful for some patients, mainly those with a basically pessimistic disposition, a general interest in philosophical questions and often using defensive strategies of stereotypy and repression.     

Scanning electron microscopy and energy dispersive analysis of machined denture base surfaces

We are seeing evidence of more studies investigating the effectiveness of psychosocial interventions of cancer patients, predominantly within groups. As roles within cancer and palliative care diversify, specially trained nurses and other health care workers are taking a more active role within psychosocial intervention studies. Frequently, these studies are randomised controlled trials (RCTs). Often, the results of these psychosocial RCTs have been laid open to general criticisms of design, implementation and reporting. The following paper focuses specifically on the general and experimenter problems in conducting RCTs within psychosocial interventions. It highlights the limitations and inherent problems seen with RCTs of psychosocial interventions so that health care workers are aware of these before considering undertaking psychosocial RCTs with cancer patients.     

Does psychosocial intervention in cancer patients affect survival and psychological well-being?]

We have critically reviewed the scientific literature examining the effect of psychosocial interventions on survival and well-being among adult cancer patients. Only studies using randomization and including a control-group not receiving psychosocial intervention were reviewed. Six studies examined the effect on prognosis. In four of these studies survival increased significantly in the intervention group as compared to the control group. All of these studies, however, have methodological flaws, leaving a possible prognostic effect to be clarified in larger, well-controlled future studies. The effect of psychosocial intervention on various psychosocial variables (such as anxiety and depression) was evaluated in 20 studies. Differences in patient populations, intervention strategies, and outcomes decrease the comparability of the results, and the majority of these studies suffer from methodological flaws as well. A positive effect on anxiety and depression immediately following the intervention is, however, reported in the majority of these studies. It is thus possible that the level of anxiety and depression may be decreased by integrating psychosocial intervention in the overall treatment of cancer.     

A risk-benefit assessment of pharmacotherapies for clinical depression in children and adolescents

Child and adolescent major depressive disorders are common and recurrent disorders. The prevalence of major depressive disorders is estimated to be approximately 2% in children and 4 to 8% in adolescents. Major depressive disorders in children are frequently accompanied by other psychiatric disorders, poor psychosocial outcome and a high risk of suicide and substance abuse, indicating the need for effective treatment and prevention. The use of antidepressant medications as the first line of treatment for children and adolescents with mild to moderate major depressive disorders has been questioned. However, some subgroups of patients may benefit from initial treatment with antidepressants. These subgroups may include patients who are unwilling or unable to undergo psychotherapy, have not responded to at least 8 to 12 sessions of psychotherapy, have bipolar, atypical or severe depression or have recurrent depression. Currently, the selective serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibitors are the first medication choice because of their efficacy, benign adverse effect profile, ease of use and low risk of death following an overdose. Further research in continuation and maintenance treatments, treatment of comorbid conditions, subtypes of depression, e.g. bipolar, atypical, seasonal, and combinations of pharmacotherapy and psychotherapy are needed. In addition, studies of the pharmacokinetics, pharmacodynamics and long term adverse effects of antidepressant medications in children and adolescents are warranted.     

Effectiveness of psychoanalytically founded brief and dynamic psychotherapy

OBJECTIVES: This study has been designed to investigate the effectivity of psychodynamic therapies. METHODS: In a naturalistic prospective longitudinal study, 117 patients are compared with 116 untreated probands. RESULTS: The improvement of the general psychosocial impairment of patients of clinical relevance and significance. The effective magnitude of change is high. Untreated patients show on the average no remission of impaired well-being and symptoms six months later. CONCLUSION: Analytically orientated short-term psychotherapy and dynamic psychotherapy are effective in the treatment of many dysthymic and anxiety disorders as well as in the treatment of a number of personality disorders.     

Foreword: Psychotherapy in later life.

This special topic issue (psychotherapy in later life) is an outcome of our increasing interest and involvement in recent years with gerontology, particularly with psychotherapy for the elderly. It reflects the new and current social, economic and political significance of this population in our society and within the helping professions. This issue encompasses a broad sampling of the present state of the art represented by contributions from recognized authorities and dedicated workers in gerontology at academic, clinical, private and government centers serving the elderly throughout the United States. The currently broad spectrum of psychotherapeutic theory, research, and practice focusing on the elderly is demonstrated in our contributors' articles. Included are works concerned with historical, psychosocial aspects, individual and group therapy, sexism and sex differences, possibilities and limitations of applying various psychotherapeutic approaches such as behavioral, environmental, psychoanalytic and cognitive. Attention is paid to special needs of the frail and dependent elderly as well as to the more vigorous and autonomous older person coping, with varying degrees of independence, in non-institutional settings. No single publication can deal effectively with the enormity of issues confronting the elderly and the range of gerotherapies. If we have opened new doors for continued progress, and stimulated more reflection and action on behalf of this population, we shall feel rewarded by having laid the seeds for a new special topic issue in the approaching decade by future investigators. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Epilogue: Psychological interventions in the changing health care systems.

Psychotherapy has utility for a wide variety of circumstances that have significant economic, personal, and social consequences. This special issue is a small attempt to address some of these problems. There are important omissions, such as the frequent use of psychotropic medications in psychotherapy, psychological rehabilitation of patients and families with chronic health problems, and hospice care. The need for establishment of a national policy on how psychotherapy can be used to create more effective and humane solutions to societal problems has been identified. The challenge is how to fund the study of health and other social problems responsive to psychotherapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Optimisation of sample presentation for the near-infrared spectra of pharmaceutical excipients

The two most common forms of hereditary ovarian cancer are: the breast ovarian cancer syndrome, and ovarian cancer associated with HNPCC (hereditary nonpolyposis colorectal cancer) syndrome. Studies have shown that these diseases may be associated with mutations in a number of tumor suppressor genes, mainly BRCA1 and BRCA2. Malfunction of the protein products of these genes have also been found to be involved in sporadic ovarian cancer, which makes up the majority of ovarian cancer cases. HNPCC-ovarian cancer associated families reveal frequent mutations in at least four genes (hMSH2, hMLH1, hPMS1, and hPMS2) involved in the repair of mismatched DNA. With ovarian cancer being such an important health issue, the push is on to design reliable screening tests to detect defective inherited or somatic alleles in individual carriers. So far, most progress has been demonstrated in those patients with family histories of the disease who are at increased risk. The ramifications of such research may impact a variety of scientific, clinical, legal, ethical, and psychosocial issues. In addition to current treatment modalities, positive results of these tests may indicate the need for increased clinical surveillance, prophylactic treatment, and genetic counseling of patients on an individual basis. It remains to be seen whether the technology can be made reliable enough to not only benefit high-risk individuals but also the general population.