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High rate of non-attendance in mental health treatment is a major problem in terms of lost economic resources and deteriorated quality of life for the patients.
The aim of the present study was to conduct an analysis of the influence of demographic and clinical variables on treatment attendance.
A naturalistic study of 2473 non-psychotic consecutive patients offered psychotherapeutic treatment. Demographic and clinical variables were registered at assessment. Bivariate and multiple logistic regression analyses of the associations between these variables and attendance were conducted.
675 (27.3%) did not show up and 289 (11.7%) dropped out of treatment. Regression analysis showed that younger age, few years of school, taking an education, unemployment, no sick leave, personality disorder, low or high GAF, no earlier treatment, no use of psychoactive medicine, and substance abuse were significant predictors for non-attendance.
No-show was predicted mainly by clinical factors, whereas drop-out was predicted by demographic variables. Results and strategies to reduce non-attendance were discussed.
In a previous study women with long-term sequalae of child sexual abuse (CSA) were randomly assigned to analytic (Group A) or systemic group psychotherapy (Group S). Pre-post-analysis indicated that both therapies led to significant improvement, but overall Group S had significantly better outcome than Group A. As gains tended to rise in Group A during follow-up and decline in Group S, no statistically significant difference was detected in gains between the two treatment modalities after one year.
This study investigates if gains are maintained five year following termination, and if the groups differ in gains.
106 women started on allocated intervention. Psychological distress (GSI from SCL-90R), psycho-social functioning (GAF), and global life quality (GLQ), were assessed before and after treatment and one and five years following termination.
86 patients (81%) completed group therapy, 68 (64%) completed the one-year follow-up and 64 (60%) the five-year follow-up. At five year follow-up ANOVA was performed using treatment group as a between factor and the four time points as repeated measures. Intention to treat analysis demonstrated that improvement were significant on all measures (P < 0.000). Independent samples t-test on gains was NS for all measures.
Women with a history of CSA who were treated with Group A or Group S treatment maintained statistical significant improvement on GSI, GAF and GLQ five years post-treatment. No significant difference was found in gains between groups.
Metabolic syndrome - a significant risk factor for cardiovascular morbidity and mortality - is twice as prevalent among psychiatric patients (21-63%) as general populations (20-24%). Although there is an inherent illness-associated metabolic risk, medications do contribute. Atypicals vary in metabolic risk from high (clozapine, olanzapine), moderate (risperidone, quetiapine) to low (aripiprazole, ziprasidone) (ADA, 2004). Few studies have comprehensively measured cardiovascular risk or directly compared antipsychotics. Limited controlled data show that antipsychotic-induced metabolic abnormalities may be reversible, rationalizing the switch to a lower-risk agent (DeNayer, 2004). Non-HDL-cholesterol encompasses all atherogenic cholesterols and provides a marker of CV risk: an increase of 29ng/dL in diabetics is associated with 50% increased risk (Jiang, 2004). Non-HDL-cholesterol is independently associated with increased risk of non-fatal myocardial infarction and angina.
This study will provide cross-European data from 13 countries on MS rates in schizophrenia and will assess antipsychotic metabolic profiles and benefits of antipsychotic switching.
In this ongoing, 16-week, open-label, European multicentre study, 258 schizophrenia patients treated for ≥3 months with olanzapine, risperidone or quetiapine and who have MS will be randomized to switch to aripiprazole (Week 1: 5mg/day; Week 2: 10mg/day; flexible 10-30mg/day after Week 2) or continue with previous antipsychotic. the primary objective is to demonstrate superiority of aripiprazole versus atypicals on mean percentage change of fasting non-HDL-cholesterol from baseline to Week 16.
This study will provide the first direct and comprehensive comparison of metabolic risk with various atypicals in Europe and should impact the future management of schizophrenia.
One out of four patients with eating disorders drop out of psychotherapeutic treatment. The high rate of dropout calls for ways to improve treatment adherence. Research indicates that continuous feedback to patient and therapist during treatment reduces the number of dropout and increases outcome; however there are only two published randomised trials on the effect of feedback on the treatment of eating disorders showing inconclusive results, and there are no randomised trials on the effect of feedback in group therapy.
We are investigating the impact of continuous feedback on dropout and outcome in group therapy. The hypothesis is that continuous feedback to patient and therapist on treatment progress and alliance will
1) reduce the number of dropouts and
2) increase treatment outcome.
We aim to discover if feedback is a way of improving adherence in group therapy for outpatients with eating disorders.
The trial is set up in a randomised design with 196 outpatients diagnosed with bulimia nervosa, binge eating disorder or eating disorder not otherwise specified, according to the DSM-IV. They are allocated to
a) systemic and narrative group therapy with feedback intervention or
b) systemic and narrative group therapy as usual.
In the experimental group, two sets of feedback measures are added to the treatment as usual: the outcome rating scale and the group session rating scale.
Results and conclusions
If the results will confirm the hypothesis, this trial will support feedback as a way to improve treatment adherence for outpatients with eating disorders.
Psychotherapeutic treatment is associated with significant reduction of symptoms in patients, and it is generally assumed that treatment improves health and decreases the need for additional health care. The present study investigates the long-term changes in utilization of health care services for patients referred to psychotherapeutic treatment in 2004 and 2005.
The study was a matched control study, which included 716 consecutive patients and 15,220 matched controls. Data from a comprehensive set of health care services were collected from central registries for an observation period of four years before intake and four years after ended treatment. Changes in utilization of health care services in eight health parameters were analyzed with t-test and with ANCOVA one and four year pre-post treatment.
Of the 761 patients, 216 patients did not show up for treatment, while 545 patients completed treatment; 228 responded and 201 did not respond to treatment. Data on treatment response was missing for the remaining 116 patients. Completer patients increased their use of all health care services with 296% (ES = 0.58) in the four year pre-post comparison, while the control group only increased with 99% (ES = 0.23). Four years after ended treatment completer patients still showed a consumption of health care services significantly above the control group on five out of eight health care parameters. Response status only affected one health care parameter.
Over a long-term period psychotherapy patients increased their utilization of health care services with a factor 3 compared to a control group.
Mental disorders are a primary cause of occupational impairments. This study investigated long-term changes in occupational functioning for patients referred to psychotherapeutic treatment at a Danish mental healthcare centre in 2004 and 2005.
We recruited 761 consecutive patients and 15,220 matched-control subjects. Data on number of days per year on sick leave, unemployment, and disability pension were collected from central registries over a 5-year observation period from 2002–2007. Differences in number of days with occupational impairments between and within groups were analyzed with t-test and with ANCOVA one and two year pre-post treatment.
Of the 761 patients, 216 patients did not show up for treatment, while 545 patients completed treatment; 228 responded and 201 did not respond to treatment. Data on treatment response was missing for the remaining 116 patients. Completer patients’ days on sick leave increased significantly from 15.7 days two years before treatment to 23.1 days two years after treatment (p < 0.000) and significant more than the control group (5.4days : 7.5 days). Similar results were found for days on disability pension (p = 0.013). Unemployment did not show any significant change for completer patients compared to the control group (p = 0.569). Variations in results were seen, depending on treatment status as no-show, responder or non-responder.
Patients that received psychotherapeutic intervention showed long-term increases in days on sick leave and disability pension.
Several studies have found that women who have experienced child sexual abuse (CSA) develop Post-Traumatic Stress Disorder (PTSD) related to their victimization experiences. The current study evaluated the presence of PTSD symptoms five years after discharge among adult women suffering from sequalae from CSA.
This randomized prospective 5-year follow-up study included 106 women: 52 assigned to psychodynamic group psychotherapy and 54 assigned to systemic group psychotherapy. PTSD symptoms were evaluated at baseline, discharge and 1 and 5 years after discharge, using the crime-related post-traumatic stress disorder scale (CR-PTSD) from the Symptom Checklist-90-Revised (SCL-90-R). ANOVA was performed using treatment group as a between factor and the four time points as repeated measures.
PTSD symptoms were significantly reduced during therapy for both groups (P < 0.000), but the systemic group exhibited significantly more reduction of PTSD symptoms than the analytic group (P < 0.002) at discharge. Difference in trajectories was found for the two groups (P > 0.005). No difference in reduction of PTSD symptoms was found between groups at 1 and 5 year follow-up.
Symptoms of PTSD were reduced in women with a history of CSA participating in both analytic and systemic specialized incest group psychotherapy. Improvement was maintained for both groups at 5-year-follow-up. The trajectories of PTSD symptoms for the two groups differed significantly, however. Implications of the difference in trajectories for treatment planning will be discussed. The findings in the present study stress the importance of long-term follow-up studies in evidence-based research.
Dark-field x-ray microscopy is intended for the acquisition of three -dimensional (3D) movies of the nanostructure (grains, domains, and dislocations) and the associated local strain within bulk materials. It is analogous to dark-field electron microscopy in that an objective lens magnifies diffracting features of the sample. The use of high-energy synchrotron x-rays, however, means that these microstructural features can be large and deeply embedded. The spatial and angular resolution is on the order of 100 nm and 0.001°, respectively, and full maps can be recorded in seconds to minutes. Four applications of the technique are presented—domain switching in ferroelectrics, processing of metals, microstructural characterization of biominerals, and visualization of dislocations. The ability to directly characterize complex, multiscale phenomena in situ—and in 3D—is a key step toward formulating and validating multiscale models that account for the entire heterogeneity of materials.
This article documents how members of the European Economic Community and members of the Arab League negotiated a draft ‘mega-regional’ investment protection treaty from 1976 to the late 1980s—the first of its kind. The negotiations produced a full draft treaty and came tantalisingly close to completion but ultimately ran into the political sands. Had it been concluded, the Convention would have been the most significant investment protection treaty ever negotiated at the time, and one of the most significant to this day. Negotiations were conducted within the cloak of diplomatic confidentiality, however, so the effort has remained unknown to even specialised scholars and practitioners to this day.
Historical sources reveals that Copenhagen was founded in the late 12th century AD by Bishop Absalon. However, during the excavation for the new metro in central Copenhagen a previously unknown early medieval cemetery was discovered and excavated at the Town Hall Square. Radiocarbon (14C) analysis was conducted on the 9 individuals found in situ, together with 11 individuals from the other early medieval cemetery in Copenhagen, belonging to the St Clemens church. The radiocarbon analysis places the onset of the cemeteries to the early 11th century AD and therefore questions the age of Copenhagen and hence the archaeological and historical perception of the Danish historical record. Here a detailed account of the radiocarbon-based Bayesian model is presented.
Oxidative stress has been suggested to increase after electroconvulsive therapy (ECT), a treatment which continues to be the most effective for severe depression. Oxidative stress could potentially be mechanistically involved in both the therapeutic effects and side effects of ECT.
We measured sensitive markers of systemic and central nervous system (CNS) oxidative stress on DNA and RNA (urinary 8-oxodG/8-oxoGuo, cerebrospinal fluid 8-oxoGuo, and brain oxoguanine glycosylase mRNA expression) in male rats subjected to electroconvulsive stimulations (ECS), an animal model of ECT. Due to the previous observations that link hypothalamic–pituitary–adrenal (HPA)-axis activity and age to DNA/RNA damage from oxidation, groups of young and middle-aged male animals were included, and markers of HPA-axis activity were measured.
ECS induced weight loss, increased corticosterone (only in middle-aged animals), and decreased cerebral glucocorticoid receptor mRNA expression, while largely leaving the markers of systemic and CNS DNA/RNA damage from oxidation unaltered.
These results suggest that ECS is not associated with any lasting effects on oxidative stress on nucleic acids neither in young nor middle-aged rats.
Metabolic syndrome (MetS) is associated with reduced life expectancy in patients with affective disorders, however, whether MetS also plays a role before the onset of affective disorder is unknown. We aimed to investigate whether MetS, inflammatory markers or oxidative stress act as risk factors for affective disorders, and whether MetS is associated with increased inflammation and oxidative stress.
We conducted a high-risk study including 204 monozygotic (MZ) twins with unipolar or bipolar disorder in remission or partial remission (affected), their unaffected co-twins (high-risk) and twins with no personal or family history of affective disorder (low-risk). Metabolic Syndrome was ascertained according to the International Diabetes Federation (IDF) criteria. Inflammatory markers and markers of oxidative stress were analyzed from fasting blood and urine samples, respectively.
The affected and the high-risk group had a significantly higher prevalence of MetS compared to the low-risk group (20% v. 15% v. 2.5%, p = 0.0006), even after adjusting for sex, age, smoking and alcohol consumption. No differences in inflammatory and oxidative markers were seen between the three groups. Further, MetS was associated with alterations in inflammatory markers, and oxidative stress was modestly correlated with inflammation.
Metabolic syndrome is associated with low-grade inflammation and may act as a risk factor and a trait marker for affective disorders. If confirmed in longitudinal studies, this suggests the importance of early intervention and preventive approaches targeted towards unhealthy lifestyle factors that may contribute to later psychopathology.
This paper reviews the effects of extended lactation (EXT) as a strategy in dairy cattle on milk production and persistency, reproduction, milk quality, lifetime performance of the cow and finally the economic effects on herd and farm levels as well as the impact on emission of greenhouse gas at product level. Primiparous cows are able to produce equal or more milk per feeding day during EXT compared with a standard 305-d lactation, whereas results for multiparous cows are inconsistent. Cows managed for EXT can achieve a higher lifetime production while delivering milk with unchanged or improved quality properties. Delaying insemination enhances mounting behaviour and allows insemination after the cow’s energy balance has become positive. However, in most cases EXT has no effect or a non-significant positive effect on reproduction. The EXT strategy sets off a cascade of effects at herd and farm level. Thus, the EXT strategy leads to fewer calvings and thereby expected fewer diseases, fewer replacement heifers and fewer dry days per cow per year. The optimal lifetime scenario for milk production was modelled to be an EXT of 16 months for first parity cows followed by an EXT of 10 months for later lactations. Modelling studies of herd dynamics indicate a positive effect of EXT on lifetime efficiency (milk per dry matter intake), mainly originating from benefits of EXT on daily milk yield in primiparous cows and the reduced number of replacement heifers. Consequently, EXT also leads to reduced total meat production at herd level. For the farmer, EXT can give the same economic return as a traditional lactation period. At farm level, EXT can contribute to a reduction in the environmental impact of dairy production, mainly as a consequence of the reduced production of beef. A wider dissemination of the EXT concept will be supported by methods to predict which cows may be most suitable for EXT, and clarification of how milking frequency and feeding strategy through the lactation can be organised to support milk yield and an appropriate body condition at the next calving.
A growing body of literature indicates that corporal punishment (CP) has the potential to adversely affect the mental and physical wellbeing of children in childhood as well as into adulthood. Corporal punishment of children in the home is legal in all states and territories in Australia, but not much is known about this type of family violence in the Australian context. This article presents a review of the literature currently available on the prevalence of CP of children in the home in Australia, covering online surveys, academic research, government data and grey literature. The role of online surveys is examined, and the lack of data available from government studies concerned with the wellbeing of children is also explored. There is found to be an overall lack of consistent data available on CP of children in the home in Australia, and this article calls on researchers and policymakers to further research and act on this aspect of family violence.
Background. Previous studies have shown a potential for cannabis in disorders of the digestive organs. We aimed to investigate whether cannabis use disorders (CUD) would decrease the risk of incident disorders of the digestive organs, in people with schizophrenia and population controls.
Methods. We combined nationwide Danish registers to identify 21 066 cases with schizophrenia and 176 935 sex-and-age-matched controls. Two models were analyzed for the associations between CUD and digestive disorders in time-varying Cox regressions: one adjusted for sex, year of birth, and calendar year; and one further adjusted for alcohol and other substance use disorders and parental education.
Results. CUD was associated with a decreased risk of developing disorders of gut–brain interaction (e.g. irritable bowel syndrome, dyspepsia, etc.) among cases with schizophrenia (HR = 0.84, 95% CI 0.74–0.94, p = 0.003). CUD was associated with decreased risk of inflammatory bowel disease (HR = 0.70, 95% CI 0.49–0.99, p = 0.045) in the basically adjusted model, dropping just below statistical significance in the fully adjusted model (HR = 0.71, 95% CI 0.48–1.03, p = 0.07). CUD displayed a tendency toward a decreased risk of serious disorders of the digestive organs among cases with schizophrenia (HR = 0.89, 95% CI 0.77–1.02, p = 0.09) in the fully adjusted model. No associations were observed among controls.
Conclusions. In people with schizophrenia, but not in controls, CUD is associated with decreased risk of disorders of gut–brain interaction and inflammatory bowel disease, and possibly other serious disorders of the digestive organs. Our findings could lead to new targets for treatment and prevention of disorders of the digestive organs.
Although cognitive-behavioural therapy (CBT) is an effective treatment for depression, less than half of patients achieve satisfactory symptom reduction during treatment. Targeting known psychopathological processes such as rumination may increase treatment efficacy. The aim of this study was to test whether adding group rumination-focused CBT (RFCBT) that explicitly targets rumination to routine medical management is superior to adding group CBT to routine medical management in treating major depression.
A total of 131 outpatients with major depression were randomly allocated to 12 sessions group RFCBT v. group CBT, each in addition to routine medical management. The primary outcome was observer-rated symptoms of depression at the end of treatment measured on the Hamilton Rating Scale for Depression. Secondary outcomes were rumination at post-treatment and depressive symptoms at 6 months follow-up (Trial registered: NCT02278224).
RFCBT significantly improved observer-rated depressive symptoms (Cohen's d 0.38; 95% CI 0.03–0.73) relative to group CBT at post-treatment on the primary outcome. No post-treatment differences were found in rumination or in depressive symptoms at 6 months follow-up, although these secondary analyses may have been underpowered.
This is the first randomized controlled trial providing evidence of benefits of RFCBT in major depression compared with CBT. Group RFCBT may be a beneficial alternative to group CBT for major depression.
Based on studies of types and recent collections, the number of species of Etlingera Giseke in the Philippines is doubled from eight to 16. Three species (Etlingera alba, E. brevilabrum and E. sessilanthera) are reported here for the first time, E. pandanicarpa is synonymised with the Bornean E. fimbriobracteata, and four new combinations (E. bulusanensis, E. linearifolia, E. pubimarginata and E. subviridis) and one new name (E. pilosa) are published here. Nine lectotypifications are proposed, of which three represent second-step designations. About two-thirds of the species are currently thought to be endemic, but future fieldwork is likely to result in more species of Etlingera in the Philippines, either endemic or as new records from neighbouring islands.