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Available evidence demonstrates that it is feasible to integrate Motivational Interviewing (MI) techniques with Enhanced Cognitive Behavioural Therapy (CBT) for the treatment of obesity and that this combined intervention has the potential to improve health-related outcomes of patients and to maintain behavioural changes over time. In addition, the use of Virtual Reality (VR) using embodiment techniques in the treatment of behavioural disorders has proved its preliminary effectiveness.
1) to adapt the embodiment tool for treating obesity in a clinical setting, and 2) to compare its preliminary effectiveness to usual care.
A randomized control trial (SOCRATES project, funded by the European Union’s H2020 program under grant agreement No 951930) will be carried out with 66 participants with a Body Mass Index (BMI) >30, who will be split into two groups (control and intervention). The participants will be recruited from the external consultations of the Vall d’Hebron University Hospital. Readiness to change, BMI, dietetic habits and physical activity, self-perception of the body size, satisfaction with self-image and quality of life in relation to body image will be assessed before and after the intervention and at 4-week follow-up. Finally, variables related to the adoption of the VR tool in terms of perceived usability, user’s satisfaction and technology acceptance will be also evaluated.
Not yet available
The study will provide an important advance in the treatment of obesity, first, by improving the effectiveness of available psychological treatments integrating embodiment, MI and CBT techniques, and second, reducing treatment duration and costs compared to conventional therapies.
Despite of the evidence of high psychopathological disorders in patients with ATSCI, few data are available on their psychiatric morbidity prior to the injury.
Identify psychiatric morbidity pre-post ATSCI in a sample of patients admitted in the Spinal Injuries Unit of the Vall d’ Hebron University Hospital in Barcelona (Spain).
Material and methods
54 patients with ATSCI patients were admitted between 1st. October 2009 and 1st. October 2010. SPSS (version 16.1) was used to analyze the data.
Seventy-six percent of the inpatients with ATSCI (41 cases) were evaluated by the psychiatrist and constitute the study sample. Twenty-seven (66%) were male and 14 (33%) female. The average age of the sample was 41 years with younger males (p < 0.05).
Reasons for ATSCI in males were traffic accident (26%), accidental falls and sports accidents (both 18.5%). In women were suicidal attempt by precipitation, fall accident (28.6% both) and traffic accident (21.4%).
41% of men versus 14% of women had a history of substance misuse (p < 0.01) while 64% of women versus the 14.8% of males had a prior psychiatric disorder (p < 0.01). 72.5% of men with ATSCI caused by traffic accident had used substances prior to the accident, those association was not found for women.
91% of patients underwent psychopharmacological intervention.
ATSCI patients exhibit high psychiatric morbidity and require specialized assessment. The high incidence of substance use associated with road traffic injuries suggests the need to identify risk groups in order to establish effective preventive measures.
Burnout syndrome (BS) is a cause of concern among doctors. Although some association between BS and psychopathology or addictive behaviour has been found, few studies evaluate its incidence in impaired physicians.
To evaluate the incidence of BS and the association with psychopathological/addictive disorders among doctors treated in a Physicians Programme of Barcelona.
66 physicians were evaluated. Variables studied included demographic, clinical and psychometric data of BS (Maslash Inventory, MBI), depression (Beck Inventory), anxiety (Spielberg S/T Inventory), general psychopathology (SCL-90-R) and personality (MCMI-II).
Forty doctors were male and 26 female. Mean age was 44.6 (8.4) years. 57.6% showed emotional exhaustion (EE), 28.8% depersonalization (D) and 10.6% lack of personal accomplishment (PA), 6.1% had complete BS. No gender differences were found. Associations between MBI and SCL-90-R subscales were (r>0.5): EE with Somatisation, Hostility and Anxiety, D with Hostility and PA with the Global severity index. BDI and STAI-S/T were associated with both three MBI factors. Correlations with MCMI-II scales (r>0.5) were: EE correlated with Avoidant and Self-Defeating, Schizotypal, Anxiety, Somatoform Disorder and Depression. D with Self-Defeating, Schizotypal, Anxiety, Somatoform Disorder, and Depression. PA with Schizoid, Schizotypal and Depression. No association was found for addictive scales.
EE is the most prevalent condition among sick doctors followed by D and PA, only 6% had complete Syndrome. As BS seems to be associated with depressive/anxiety symptoms, hostility and Schizotypal personality traits, such patients may be a target group for prevention and training in assertiveness and communication skills.
Patients suffering from Functional Gastrointestinal Disorders (FGD) experience a high degree of psychological discomfort difficult to measure with current psychometric tools.
- To describe the presence of affective symptoms measured with the Hospital Anxiety Depression (HAD) Scale in FGD inpatients.
- To analyze the differences in HAD subscales scores between motor functional gastrointestinal disorders (MFGD) and non-motor functional gastrointestinal disorders (NMFGD).
Material and method
46 inpatients admitted to the Vall d’Hebron Digestive System Research Unit to study the existence of FGD were evaluated from January 2008 to July 2010. All patients completed the HAD scale and results from the two HAD subscales - Anxiety subscale (HAD-A) and Depression subscale (HAD-D)- were analyzed.
The mean age of the sample was 41.02 ± 16.86 years, 89.1% were women and 10.9% were men. Thirty-one patients met criteria of NMFGD, 13 of MFGD, and 2 did not met criteria of both diagnoses. The mean scores of the HAD were: HAD-A = 8.12 ± 5.23) and HAD-D = 5.20 ± 4.20. MFGD patients’ HAD results were: HAD-A = 7.00 ± 5.74 and HAD-D = 4.55 ± 4.52 while NMGFD HAD results were: HAD-A = 8.21 ± 4.98 and HAD-D = 4.96 ± 3.77. No statistically significant differences were found between both groups.
According to our findings, MFGD patients do not meet HAD criteria of anxiety or depression while NMFGD patients only fulfill criteria for probable anxiety or depression. New psychometric tools should be developed in the future to study the psychological discomfort these patients usually complain of.
Physicians presenting with addictive behaviours and mental illness can be a considerable challenge for psychiatrists. Impaired physicians usually tend to act as doctors while eschewing the role of a patient, which can result in poor compliance, self-diagnosis and self-medication. The psychiatrist confronted with such a patient may react defensively and not take into consideration the needs of the patient. On the other hand, when appropriately handled, impaired physicians can be an enormous source of help for themselves. An appropriate setting and the therapeutic relationship are key for reaching this goal.
To identify the basic clinical problems posed by impaired physicians.
To provide trainees with basic skills to effectively treat impaired colleagues.
To demonstrate how to take advantage of the patients' professional status.
To outline the basic characteristics and functioning of a specialized program for impaired physicians.
The contents of the course will include:
Basic concepts: the impaired physician.
Risk factors in the medical professions.
Some epidemiological data: Addictive and mental disorders in physicians.
The doctor as patient: What makes him/her different?
Alexithymia is said to be an important feature of functional gastrointestinal disorders (FGD). Most studies focus on the presence of alexithymia in patients suffering non-motor FGD (NMFGD) but few studies have analyzed its occurrence in motor FGD (MFGD) patients.
- To describe the presence of alexithymia, measured with the Toronto Alexithymia Scale (TAS-20), in a sample of FGD inpatients.
- To analyze the differences in alexithymia, measured with the TAS-20, between MFGD and NMFGD inpatients.
Material and method
46 inpatients admitted to the Vall d’Hebron Digestive System Research Unit to study the existence of FGD were evaluated from January 2008 to July 2010. All patients completed the Toronto Alexithymia Scale (TAS-20).
The mean age of the sample was 41.02 ± 16.86 years, 89.1% were women and 10.9% were men. With regard to their diagnostic condition, 31 met criteria of NMFGD, 13 of MFGD, and 2 did not met criteria of both disorders. The mean TAS-20 total score was: 46.24 ± 13.60. MFGD patients obtained a mean score of 45.45 ± 12.53, and patients with NMFGD had a mean score of 45.75 ± 12.53. No statistically significant differences were found between both subtypes with regard to alexithymia.
Alexithymia, measured with the TAS-20, may not be present in FGD. Discordances of our results with previous findings in FGD may be due to complex psychosocial factors and to psychometric difficulties in assessing alexithymia in this group of patients.
There is no general agreement on the prevalence of mental disorders in the elderly, although it is estimated that 25%. of them present psychiatric symptoms. Geriatric psychiatry is one of the most rapidly advancing fields and requires a comprehensive approach.
To analyse the characteristics of patients older than 65 who are attended at the psychiatry emergency room.
A descriptive study was conducted among all elderly pacients seen during May 2010 at the psychiatry emergency room at Vall d’Hebron University Hospital. Clinical variables (functional status, reason to show up, medical history, diagnosis), treatment and referral at discharge were analysed.
36 patients (44.4% men, mean age 75.3 years) were identified. Charlson comorbidity index was 2.08. Suicide attempts were the most frequent reason for admission (27.8%), followed by psychomotor agitation (16.7%), anxiety disorders (13.9%), delirium (13.9%), depression (11.1%), and behaviour disorders (8.3%). Concerning psychiatric antecedents 58.3% had depressive disorder and 40% reported somatic symptoms during the month prior to their consultation.
The most common diagnosis at discharge were anxiety-depressive disorders (52.7%) and delirium (16.7%). The most widely prescribed psychotropics were antipsychotics (19.4% haloperidol, 13.9% quetiapine) followed by benzodiazepines (13.9%). Referral at discharge was: 41.7% home, 13.9% midterm psychiatric units, 27.8% acute psychiatric inpatient unit and 16.7% Internal Medicine.
Typically, elderly patients attended at the psychiatric emergency room are diagnosed of an anxiety-depressive disorder and often present with a suicidal attempt, but only 41.7% are admitted as psychiatric inpatients.
Non-specific chronic low back pain is one of common causes of disability and a recurrent medical complaint with high costs. From rehabilitative medicine, physiotherapy programs and general postural recommendations are offered. Although this treatment is aimed to reduce disability, severity of pain and anxiety-depressive symptoms, many patients report partial improvements and recurrence of pain. Therefore, a new approach to treat this pathology with a broaden focus on psychososocial issues that might modulate pain and its evolution is required.
Aims and hypothesis
To assess the effectiveness of two complementary interventions to physiotherapy, such as relaxation techniques (specifically, sophrology) and cognitive behavioral intervention. It is hypothesized that intervention groups will significantly improve their adherence to physiotherapy and will gain control over their pain. Ultimately, this will foster better quality of life.
Longitudinal design with pre-post intervention measures and follow-up appointments (at 6 and 12 months) carried out in a sample of 66 participants. The sample will be divided into three groups: control (physiotherapy), intervention group 1 (physiotherapy & sophrology) and intervention group 2 (physiotherapy & cognitive behavioral intervention). In all groups biomedical aspects regarding type, evolution and characterization of pain as well as several psychosocial factors will be assessed.
Preliminary results are expected by December 2013.
If hypotheses are confirmed, we will be able to provide empirical evidences to justify a multidisciplinary care model for chronic low back pain, which will favor a significant cost reduction in terms of health care and human suffering.
TBI is a significant health problem which often affects young people with high life expectancy and it is associated with a high rate of psychological morbidity. Symptoms such lack of attention and apathy are responsible for a significant degree of discomfort that interferes negatively on the quality of life. Cognitive remediation and treatment with stimulants seem to be useful in these patients, however, few studies are been conducted about the most appropriate management of TBI patients.
Systematic review the existing evidence on the combined use of psychostimulants and cognitive remediation in the treatment of attention problems in patients with TBI.
Performs search in PUBMED and PsycINFO of randomized controlled trials in TBI patients with a psychostimulants and cognitive remediation groups. Analyses the effect of these interventions in a variety of measures attention.
Randomized controlled trials have examined the combined effect of psychostimulants and cognitive rehabilitation. Preliminary results indicate that the mix of strategies is more effective than cognitive rehabilitation and the use of psychostimulants separately. It is described the effectiveness of the combination as well as psychostimulants used and the effect on other symptoms as apathy and slackness.
The effectiveness of both treatments warranted of protocols standardized in the early management of attention difficulties in patients with TBI.
Doctors face difficulties when they are sick and have to take the patients’ role, and those barriers can be insurmountable when the problem is an addiction or other mental health disorders. On the other hand, treating sick doctors is more challenging than addressing the same problems in the general population, but not much has been published on the difficulties experienced by doctors treating doctors, specially when this happens in the psychiatric arena. The Physician Health Program (PAIMM) of Barcelona (Spain) is dedicated to the attention of doctors affected by mental disorders and / or addictive behaviours. The program is has also links with psychiatrists all over Spain who take care of patients once discharged.
Objectives and methodology
The goal is to present the results of a survey that describes the experience of psychiatrists who treat sick doctors. The survey itself consists of 25 items, scored on a Likert scale of 5 points and three qualitative questions about their experience as psychiatrists treating patients. The survey were sent to 57 psychiatrists a link to allow for anonymous response through an online system was included in the invitation.
Results and conclusions
41 responses (74, 5%) have been collected. Psychiatrists believe that treating physicians is more difficult than treating other patients. The difficulties identified are the need of better communication skills and longer interviews. The assessment of readiness to return to work is also very challenging. However, despite the difficulties, the majority of respondents are satisfied with the experience of treating colleagues.
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